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Fivefold reduction in peritonitis using a multifaceted continuous quality initiative program.

Diane Borg1, Anupkumar Shetty, Deborah Williams

  • 1Division of Nephrology and Hypertension, Henry Ford Hospital, Greenfield Health Systems, Detroit, Michigan, USA.

Advances in Peritoneal Dialysis. Conference on Peritoneal Dialysis
|February 7, 2004
PubMed
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Implementing a continuous quality initiative significantly reduced peritonitis rates in peritoneal dialysis (PD) patients. This program involved patient retraining, protocol changes, and optimizing PD connection systems, leading to improved patient outcomes.

Area of Science:

  • Nephrology
  • Dialysis Technology
  • Infectious Disease Prevention

Background:

  • Peritonitis remains a significant clinical challenge for patients undergoing peritoneal dialysis (PD), despite advancements in PD systems.
  • Identifiable and modifiable risk factors for peritonitis necessitate targeted interventions.
  • Observed variations in peritonitis rates across different PD connection systems in 1998 highlighted a need for improvement.

Purpose of the Study:

  • To reduce peritonitis rates in patients on peritoneal dialysis through a multifaceted continuous quality initiative (CQI) program.
  • To evaluate the impact of specific interventions, including patient retraining, equipment modifications, and manufacturer choice, on peritonitis incidence.

Main Methods:

  • Initiated a comprehensive CQI program in January 1999.

Related Experiment Videos

  • Included retraining all current and new PD patients, transitioning to titanium adapters, and standardizing PD equipment from a single manufacturer.
  • Taught specific techniques for using solution bags and exchange devices to minimize contamination risks.

    • Main Results:

    • Peritonitis rates improved significantly, decreasing from 1 episode per 7.5 patient-months in 1998 to 1 episode per 36.5 patient-months by September 2002.
    • A statistically significant difference in peritonitis rates was observed between different automated peritoneal dialysis (APD) systems and continuous ambulatory peritoneal dialysis (CAPD) connection systems.
    • Specific systems showed marked differences: Freedom Cycler PD+ (Fresenius) had a higher rate (1:6.9 patient-months) than HomeChoice cycler (Baxter) (1:23.9 patient-months); Premier Double Bag (Fresenius) had a higher rate (1:6.3 patient-months) than UltraBag (Baxter) (1:26 patient-months).

    Conclusions:

    • Ongoing continuous quality improvement (CQI) efforts are effective in significantly reducing peritonitis rates in PD patients.
    • Key components of successful CQI include rigorous patient retraining, protocol standardization, use of advanced connection components like titanium adapters, and careful selection of PD connectology systems.
    • The choice of PD equipment manufacturer and specific connectology systems can influence peritonitis rates, suggesting a potential supplier-dependent effect.