Abstract
BackgroundIn hemodialysis (HD) patients, central venous catheter (CVC) related bloodstream infections are a major cause of morbidity and mortality. Hygienic precautions are a key aspect of dialysis care for infection prevention, but they are not sufficient to completely avoid the occurrence of CVC related infections. During the COVID-19 pandemic, hygienic precautions for preventing viral transmission have been markedly reinforced. We evaluated their effects on CVC-related infection rates.MethodsAn observational retrospective study was conducted in two hemodialysis units of the same institution treating 215 chronic hemodialysis patients, 71 of whom are currently (33%) using a CVC. In the CVC cohort, we compared data on catheter-related infection rates during the maximum spread of the COVID-19 pandemic in Italy (February to May 2020) with data from the same period of the previous year and with the whole of 2019.ResultsIn 2019, we recorded a catheter-related bloodstream infection (CRBSI) rate of 1.19 (95% CI 0.81–1.68)/1000 days [2.07 (95% CI 1.12–3.52)/1000 days in the Feb-May 2019 period] and a tunnel and exit-site infection rate of 0.82 (95% CI 0.51–1.24)/1000 days [1.04 (95% CI 0.41–2.15)/1000 days in the Feb–May 2019 period]. Infection rates drastically decreased during the COVID-19 pandemic, with just one catheter-related bloodstream infection being recorded. Catheter-related bloodstream infection rates showed a significant reduction to 0.20 (95% CI 0.01–0.9)/1000 days (p < 0.05 and p < 0.005 compared to 2019 and to Feb-May 2019, respectively) and a non-significant reduction in tunnel and exit-site infections to 0.6 (95% CI 0.15–1.6)/1000 days.ConclusionsThe observed 91% reduction in catheter-related bloodstream infections compared to the same period in 2019 [IRR 0.09 (95% CI 0.002–0.64)] and the 83% reduction compared to the whole of 2019 [IRR 0.17 (95% CI 0.004–1.009)] suggest that a stricter implementation of hygienic precautions in the dialysis setting can markedly improve the problem of CVC-related infections.Graphic abstract
Highlights
Infections are common complications among patients on chronic hemodialysis (HD), representing the main cause of morbidity and the second cause of death, following cardiovascular events, in this population
Among HD patients, those with central venous catheter (CVC) experience a much higher risk of death, infection, cardiovascular events, and hospitalization compared with patients who undergo hemodialysis with an arteriovenous fistula or a graft
Catheter-related bloodstream infections, exit-site infections, and tunnel infections are frequent complications related to HD-CVC
Summary
Infections are common complications among patients on chronic hemodialysis (HD), representing the main cause of morbidity and the second cause of death, following cardiovascular events, in this population. Infection-related hospitalization risk was highest for patients dialyzing with a catheter at initiation of dialysis (RR 1.47) and throughout follow-up (RR 2.31), compared to patients with arteriovenous (AV) fistula [2]. This retrospective observational study aims to assess the effect of stricter infection prevention policies adopted during the COVID-19 pandemic on CVC infection rates. During the COVID-19 pandemic, hygienic precautions for preventing viral transmission have been markedly reinforced We evaluated their effects on CVC-related infection rates. Conclusions The observed 91% reduction in catheter-related bloodstream infections compared to the same period in 2019 [IRR 0.09 (95% CI 0.002–0.64)] and the 83% reduction compared to the whole of 2019 [IRR 0.17 (95% CI 0.004–1.009)] suggest that a stricter implementation of hygienic precautions in the dialysis setting can markedly improve the problem of CVC-related infections
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