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Use of ClearGuard HD caps in pediatric hemodialysis patients
Amy Nau1, Troy Richardson2, Diana Cardwell3
1Division of Pediatric Nephrology, Children's Mercy Kansas City, Kansas City, MO, USA. aenau@cmh.edu.
Insights
Routine use of ClearGuard caps significantly reduced catheter-related bloodstream infections (CA-BSIs) in pediatric hemodialysis (HD) patients. This study highlights the effectiveness of these caps in preventing serious infections in children undergoing dialysis.
Area of Science:
- Pediatric Nephrology
- Infectious Disease Prevention
- Dialysis Technology
Background:
- Bloodstream infections (BSIs) are a major cause of morbidity and mortality in pediatric hemodialysis (HD) patients, particularly those with central venous catheters (CVCs).
- Chlorhexidine-impregnated catheter caps (ClearGuard) have shown promise in reducing HD catheter-related BSIs (CA-BSIs) in adults, but pediatric data were lacking.
Purpose of the Study:
- To evaluate the impact of ClearGuard caps on CA-BSI rates in pediatric HD patients.
- To compare CA-BSI incidence between centers using and not using ClearGuard caps.
Main Methods:
- A comparative analysis of CA-BSI data from pediatric HD centers within the Standardizing Care to Improve Outcomes in Pediatric Endstage Kidney Disease (SCOPE) collaborative.
- Centers were categorized as ClearGuard (CG) or non-ClearGuard (NCG) based on cap usage, with pre- and post-implementation data reviewed.
- Infectious disease physicians adjudicated all positive blood cultures reported to the SCOPE collaborative.
Main Results:
- Data from 1786 patients (January 2016-January 2022) were analyzed, with January 2020 as the implementation cutoff.
- Post-January 2020, CG centers showed a significantly greater reduction in HD CA-BSI rates compared to NCG centers (1.18 to 0.23 vs. 0.41 episodes/100 patient-months, p=0.002).
Conclusions:
- Routine use of ClearGuard caps in pediatric dialysis centers is associated with a significant reduction in HD CA-BSI rates.
- This finding supports the adoption of ClearGuard caps for enhancing patient safety in pediatric hemodialysis settings.
Background:
Bloodstream infections (BSIs) are a leading cause of hospitalizations and mortality among patients receiving hemodialysis (HD) therapy, especially those with a central venous catheter (CVC) for dialysis access. The use of chlorhexidine impregnated catheter caps (ClearGuard) has been associated with a decrease in the rate of HD catheter-related BSIs (CA-BSIs) in adults; similar data have not been published for children.
Methods:
We compared CA-BSI data from participating centers within the Standardizing Care to Improve Outcomes in Pediatric Endstage Kidney Disease (SCOPE) collaborative based on the center's use of ClearGuard caps for patients with HD catheter access. Centers were characterized as ClearGuard (CG) or non-ClearGuard (NCG) centers, with CA-BSI data pre- and post-CG implementation reviewed. All positive blood cultures in participating centers were reported to the SCOPE collaborative and adjudicated by an infectious disease physician.
Results:
Data were available from 1786 SCOPE enrollment forms completed January 2016-January 2022. January 2020 served as the implementation date for analyzing CG versus NCG center data, with this being the time when the last CG center underwent implementation. Post January 2020, there was a greater decrease in the rate of HD CA-BSI in CG centers versus NCG centers, with a decrease from 1.18 to 0.23 and 0.41 episodes per 100 patient months for the CG and NCG centers, respectively (p = 0.002).
Conclusions:
Routine use of ClearGuard caps in pediatric dialysis centers was associated with a reduction of HD CA-BSI rates in pediatric HD patients.
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