Re-training and switching of PD system to reduce recurrent gram-positive PD peritonitis

Intensive training and re-education of peritoneal dialysis (PD) exchange technique has been advocated to minimize peritonitis rate. However, re-education of patients that are established on PD for some years can be difficult and a minority of patients on PD remain susceptible to repeated episodes of peritonitis. The UV Flash Compact system (Baxter Healthcare) automates patient connection and disconnection during the PD exchange procedure and uses bactericidal UV irradiation to minimise the effects of touch contamination. We have explored the efficacy of retraining patients using this system for reducing peritonitis rates in a cohort of 10 patients in who repeated episodes of peritonitis due to gram +ve organisms suggest irrevocable breaches in sterile technique. These patients were converted from their existing PD system (6 Staysafe [Fresenius Medical Care], 4 Mini-solo [Baxter]). Mean follow up post-conversion was 10 months. There was a striking reduction in peritonitis caused by gram +ve pathogens from 1 in 8.5 to 1 in 50.5 months. Although it is not possible in this study to differentiate the impact of the UV Flash Compact as opposed to the effect of re-training, we advocate that patients with a high peritonitis burden from gram +ve organisms should be considered for conversion to the UV Compact system.