Clinical Implementation of an Adapted Infection Risk Screening Tool Following Nurse-Led Haemodialysis Vascular Access...

Area of Science:

• Nephrology
• Infectious Disease Epidemiology

Background:

• Healthcare-associated infections are a significant cause of morbidity and hospitalizations in haemodialysis patients.
• Vascular access infections pose a substantial clinical and economic burden.

Purpose of the Study:

• To evaluate an adapted British Renal Society Infection Risk Screening Tool for identifying haemodialysis patients at high risk of infection-related hospitalizations.
• To assess the tool's utility in informing decisions regarding buttonhole needle puncture for vascular access.

Main Methods:

• Retrospective cohort study of 404 adult haemodialysis patients between January 2022 and December 2024.
• Data collected included demographics, comorbidities, vascular access status, and screening classification (risk present/absent).
• Primary outcome: at least one infection-related hospitalization within 12 months.

Main Results:

• The screening tool classified 27.8% of patients as "risk present".
• Patients classified as "risk present" had a modestly increased, though imprecise, odds of infection-related hospitalization (adjusted OR 1.73).
• Older age was associated with increased risk, while higher body-mass index appeared protective; diabetes and dialysis vintage were not significant predictors.

Conclusions:

• The dichotomized screening tool showed limited ability to predict infection risk, with age and nutritional status being more influential.
• The tool may assist in cautiously selecting patients for whom buttonhole puncture could be de-selected.
• Further refinement and prospective validation of the screening tool are necessary.