Dallas—Infection, the second leading cause of death in patients with end-stage renal disease, is associated with increased hospitalization rates and increased healthcare costs. Approximately 19% of dialysis procedures nationwide involve central venous catheters (CVCs); CVCs are associated with 70% of access-related blood stream infections in patients with ESRD receiving hemodialysis therapy.
According to Norma Gomez, MBA, MSN, RN, CNNe, decreasing the number of CVCs in this patient population should be a priority for nephrology nurses. Patients who receive dialysis via a CVC belong primarily to one of two groups: patients with multiple failed accesses and patients who initiate hemodialysis with a CVC. Strategies to reduce use of CVCs and thus CVC-related blood stream infections include vascular access programs, zero tolerance of infection programs, patient and staff education, physician-nurse alignment, use of triple-antibiotic ointment at the exit site, impregnated catheters, and antibiotic lock solutions.
Ms. Gomez, of Satellite Healthcare, San Jose, California, described a program designed to decrease use of CVCs at the 2019 ANNA National Symposium in a presentation titled Reducing Infections in Hemodialysis Patients.
The initial effort involved implementation of the Wipe Out Catheter (WOC) program, using a seven step process for the assessment and evaluation of each CVC patient. Use of WOC has resulted in a company-wide CVC rate of 8.9%.
For patients who continued to use a CVC, clinicians established a low dose, gentamicin-citrate lock protocol. Approximately 5000 patients using a CVC for hemodialysis access were monitored over a 3-year period for CVC lock related bloodstream infections using National Healthcare Safety Network protocol. The centers also addressed the safety concern for resistance development and added the use of triple antibiotic ointment at the CVC site. Over the three years of the project, the rate of bloodstream infections related to CVCs was 1.00 episodes per 100 patient months, 50% lower than the national average of 2.02 per 100 patient months.
In summary, Ms. Gomez said, “The reduction in the number of CVCs, combination of triple antibiotic ointment on the exit site and a gentamicin-citrate lock reduced infections in CVC patients by more than 50% consistently over 3 years with no evidence of emerging gentamicin resistance, and no evidence for CVC breakdown. Due to these findings, these strategies became the standard of care for our patients.”
Source: Gomez N. Reducing infections in hemodialysis patients. Abstract of a presentation at the 2019 American Nephrology Nurses Association National Symposium, April 14-17, 2019, Dallas Texas.