Optimizing exit-site care for hospitalized peritoneal dialysis patients with weekly chlorhexidine-impregnated...

IntroductionPeritoneal dialysis (PD) catheter exit site care is crucial to prevent exit site or tunnel tract infection. Daily exit site care for hospitalized PD patients can be time-consuming for nurses. Therefore, an alternative approach with less frequent exit site care is needed.MethodsThe quality improvement (QI) initiative was conducted at a single center in Singapore from August 2021 to February 2022, during the COVID-19 pandemic. This initiative aimed to reduce nursing time spent on exit site care for hospitalized PD patients using weekly chlorhexidine-impregnated sponge dressings.ResultsA total of 211 PD patients received weekly chlorhexidine-impregnated dressings during their admission. The total length of stay was 3714 days, with a median stay of 6 (interquartile range: 3-13) days per patient. Most patients were Chinese (78%), and 59% were male. PD nurses spent a median of 104.9 min (Interquartile range [IQR]: 99.3-129.7) per patient per month on exit-site care with daily antibiotic dressing before this initiative. After the QI initiative, this was reduced to 31.3 min (IQR: 26.6-31.6), achieving a 70% reduction. A total of 696 chlorhexidine dressings were used, instead of an estimated 3714 conventional dressings. Nursing time for dressing changes was 116 h with chlorhexidine, versus an assumed 619 h with conventional daily dressing, resulting in a net saving of 503 h. The total cost for chlorhexidine dressings was Singapore Dollars (S$) 20,880, compared to estimated S$ 74,280 for conventional dressings, yielding a net savings of S$ 53,400. No patients developed exit-site infections, and no adverse events were observed with the chlorhexidine dressings.ConclusionsThe QI initiative showed that weekly chlorhexidine-impregnated dressing significantly reduced nursing time for exit-site care in hospitalized PD patients without short-term adverse events, potentially lowering healthcare costs.