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

Background: Healthcare-associated infection drives morbidity and unplanned hospital use in haemodialysis. We aimed to determine whether an adapted British Renal Society Infection Risk Screening Tool, applied during a nurse-led vascular access consultation, identifies patients at increased risk of subsequent infection-related hospitalisation and can inform de-selection of buttonhole puncture. Methods: We conducted a retrospective cohort of 404 adults reviewed between 1 January 2022 and 31 December 2024. Baseline demographics, comorbidities, vascular access status and screening classification ("risk present/absent") were retrieved from records. The primary outcome was ≥1 infection-related hospitalisation within 12 months; the number of such admissions was secondary. Results: Mean age was 70.2 years; 47% had diabetes; 27.8% screened "risk present". Forty-eight patients (11.9%) were hospitalised for infection. "Risk present" showed higher-though imprecise-odds of infection-related admission versus "risk absent" (adjusted OR 1.73; 95% CI 0.90-3.27). Older age increased risk, whereas higher body-mass index appeared protective; diabetes, central venous catheter and dialysis vintage were not significant. Conclusions: The dichotomised screening classification identified only a modest elevation in risk, with age and nutritional status exerting greater influence. The tool may support cautious de-selection of buttonhole in higher-risk individuals, but refinement and prospective validation are required.