ISPD guideline-driven retraining, exit site care and decreased peritonitis: a single-center experience in Israel

Area of Science:

• Nephrology
• Infectious Disease Management
• Patient Education

Background:

• Peritonitis is a major complication in peritoneal dialysis (PD), leading to treatment failure and increased morbidity.
• Catheter exit site infections are a primary source of PD-related peritonitis.
• Effective patient education and meticulous site care are crucial for preventing PD complications.

Purpose of the Study:

• To evaluate the effectiveness of a combined educational retraining program and a strict catheter exit site care protocol.
• To determine the impact of these interventions on reducing the incidence of peritonitis in prevalent PD patients.

Main Methods:

• An interventional study involving prevalent PD patients over a 9-year period (2009-2017).
• Data collected across three distinct periods: pre-intervention, post-educational intervention, and post-educational plus exit site care protocol implementation.
• Peritonitis rates, causative organisms, and patient outcomes were assessed and compared across the three study periods.

Main Results:

• The combined interventions significantly decreased peritonitis rates from 1.05 to 0.67 episodes per patient-year (p=0.017).
• The proportion of peritonitis-free patients increased substantially from 27.4% to 55.6% (p=0.001).
• Coagulase-negative Staphylococcus, Pseudomonas, and Staphylococcus aureus were the most frequent causative pathogens.

Conclusions:

• Implementing a comprehensive educational program and enforcing a strict catheter exit site care protocol led to a significant reduction in peritonitis.
• These interventions are vital for improving the safety and efficacy of peritoneal dialysis therapy.