Using a Multidisciplinary Training Program to Reduce Peritonitis in Peritoneal Dialysis Patients

Abstract

<jats:sec><jats:title>♦Objectives</jats:title><jats:p>The present study evaluated the tool used to assess patients’ skills and the impact on peritonitis rates of a new multidisciplinary peritoneal dialysis (PD) education program (PDEP).</jats:p></jats:sec><jats:sec><jats:title>♦Methods</jats:title><jats:p>After the University Hospital Ethics Committee approved the study, the educational and clinical records of PD patients were retrospectively analyzed in two phases. In phase I, an Objective Structured Assessment (OSA) was used during August 2008 to evaluate the practical skills of 25 patients with adequate Kt/V and no mental disabilities who had been on PD for more than 1 month. Test results were correlated with the prior year's peritonitis rate. In phase II, the new PDEP, consisting of individual lessons, a retraining schedule, and group meetings, was introduced starting 1 September 2008. Age, sex, years of education, time on PD, number of training sessions, and peritonitis episodes were recorded. Statistical analyses used t-tests, chi-square tests, and Poisson distributions; a p value of less than 0.05 was considered significant.</jats:p></jats:sec><jats:sec><jats:title>♦Results</jats:title><jats:p>In phase I, 25 patients [16 men, 9 women; mean age: 54 ± 15 years (range: 22 – 84 years); mean time on PD: 35 ± 30 months (range: 1 – 107 months)] were studied. The OSA results correlated with peritonitis rates: patients who passed the test had experienced significantly lower peritonitis rates during the prior year ( p &lt; 0.05). In phase II, after the new PDEP was introduced, overall peritonitis rates significantly declined (to 0.28 episodes/patient–year from 0.55 episodes/patient–year, p &lt; 0.05); the Staphylococcus peritonitis rate also declined (to 0.09 episodes/patient–year from 0.24 episodes/patient–year, p &lt; 0.05).</jats:p></jats:sec><jats:sec><jats:title>♦Conclusions</jats:title><jats:p>The OSA is a reliable tool for assessing patients’ skills, and it correlates with peritonitis rates. The multidisciplinary PDEP significantly improved outcomes by further lowering peritonitis rates.</jats:p></jats:sec>

The Current State of Peritoneal Dialysis

“…179 Single center observational studies from different parts of the world, as well as multinational national registry studies have reported that the rates of PD-related infections have steadily decreased over the last 10-20 years. 180,[186][187][188][189][190][191][192][193] Within Australia, country-wide PD-related peritonitis rates fell significantly by 37% over a 5-year period from 0.62 episodes per patient-year in 2008 to 0.39 episodes per patient-year in 2013 after a concerted, multidisciplinary and multipronged national peritonitis reduction campaign involving quarterly audit and feedback of individual unit peritonitis rates, prioritization of peritonitis prevention trials by the Australasian Kidney Trials Network, updating national clinical practice guidelines on peritonitis, launching peritonitis guideline implementation projects, publishing of a call to action paper, establishment of a PD Academy to provide PD training to junior nephrologists and nursing staff, and development of a Home Dialysis Network to support home dialysis patients (http:// homedialysis.org.au/). 161,[180][181][182][183][184][185] These reductions have been variously attributed to the use of twin bag disconnection systems, implementation of mupirocin chemoprophylaxis protocols, topical exit site application of gentamicin, coprescription of nystatin or fluconazole with antibiotic therapy, improved training of PD patients and/or staff, and better identification and targeting of peritonitis risk factors.…”

Teaching peritoneal dialysis in Australia: An opportunity for improvement

“…International Society for Peritoneal Dialysis Guidelines recommend the inclusion of the concepts of adult learning principles in the curriculum for future PD trainers to facilitate the subsequent training of PD patients . Indeed, the two trials to date incorporated these principles within their curriculum; however, it has not been shown that this is a required component . The current survey demonstrated that adult learning principles are not widely incorporated in PD units around Australia, with less than 50% of PD units assessing patients' learning styles.…”

Microbiological evaluation safety cap in peritoneal dialysis

“…En nuestra revisión se encontró una adherencia a la técnica de conexión del 87%, lo cual evidencia el trabajo de capacitación y educación continua con el paciente, la no adherencia es del 13% siendo similar al 10% reportado en la literatura [46][47][48][49][50][51][52] .…”