Reduction of Tunnelled Haemodialysis Catheters Related Infections by Intervention and Training: A 12 and 18-month Audit

Abstract

Introduction: Catheter-Related Blood Stream Infections (CRBSI) are an important complication of both non tunnelled and tunnelled haemodialysis catheters, but are often poorly reported for tunnelled haemodialysis-catheters. Aim: To assess the rate, aetiology, and outcomes of CRBSI in patients using a tunnelled catheter at 12-month and 18-month audits at the newly-opened haemodialysis unit having care bundle as a part of routine catheter care. Materials and Methods: A retrospective cross-sectional study involving two audits of CRBSI risk (12-month and 18-month audit) was conducted by the dialysis unit doctors and nursing staff at Medanta Super-Specialty Private Hospital, Indore, Madhya Pradesh, India. Centres for Disease Control (CDC) and prevention core intervention/care bundle for Blood Stream Infections (BSI) reduction were incorporated as a part of routine catheter care. The 12-month (May 2018 to April 2019) and 18-month (May 2018 to November 2019) internal clinical audit were evaluated to assess the impact of care bundle on incidence of CRBSIs. Kidney-Disease- Outcome Quality-Initiative (KDOQI)-2006-criteria was used to define CRBSI. Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) version 19.0 software (IBM Corporation, New York, United States). Descriptive and dispersion statistical analysis was done for studied variables. Results: Total patients in 12-months audit with tunnelled haemodialysis catheter were 14 (7 male and 7 female) with median age 64 years and in 18-months audit patient with tunnelled haemodialysis catheter were 18 (11 male and 7 female) with median age 67.5 years. CRBSI incidence was 2.58 per 1000 catheter days at the end of 12-month, with 132 (71.25-202.25) days of median catheter use. Over the 18-month, the incidence of CRBSI dropped to 1.99 per 1000 catheter days. Median period of catheter use increased to 149.5 (83.5-294.5) days. The primary organisms isolated were predominantly gram negative bacterias. Conclusion: Tunnelled catheters may be a reasonable alternative vascular access for haemodialysis in patients with arteriovenous fistula failure as implementation and maintenance of multidisciplinary care bundle reduces CRBSI rate in such patients.