New research was presented at Kidney Week 2020 Reimagined, the virtual annual meeting of the American Society of Nephrology.
Increased risk of hemodialysis catheter-related bloodstream infections (HD-CRBSIs) are a major morbidity associated with the use of central venous hemodialysis catheters, evidence indicates. However randomized trials testing systematic interventions to reduce this burden are lacking. With study investigators finding a wide variation in practice of catheter care upon surveying 48 renal services, they implemented a suite of evidence-based interventions at 37 locations during three phases: at insertion of the hemodialysis catheter, during catheter maintenance, and during the removal of the catheter. Outcomes prior to the intervention were compared with those during the nearly 29-month intervention phase. Event rates for confirmed HD-CRBSI were 0.313 per 1,000 catheter days prior to the invention and 0.240 per 1,000 catheter days during. The intervention also did no reduce rates of suspected possible HD-CRBSI (RR, 0.54), confirmed and suspected/possible HD-CRBSI (RR, 0.97), total HD-CRBSI-related infection (RR, 0.71). Also, no differences were seen in pre-specified sub-group analysis, including in service sizes less than a median of 63 patients (RR, 1.07) or larger than 63 patients (RR, 1.14), when assessing only patients who required a change to dressing or catheter-locking solution during the intervention (RR, 1.15) or when limited only to patients who didn’t require this during the intervention (RR, 1.31). The presenting author highlights that although the intervention failed to reduce the number of bloodstream infections, the total rate remained generally low at a national level.