Peritonitis prevented in continuous ambulatory peritoneal dialysis by using the Hong Kong connection

Based on the hypothesis that air contamination is an important cause of peritonitis in continuous ambulatory peritoneal dialysis, a simple and cheap connection system was developed whereby a clear polyethylene bag containing an antiseptic gauze was used as a sterilising chamber, effectively enclosing the connection procedure. Seven modifications to the connection technique were introduced over 32 months in 28 patients during 27.9 patient years of experience. The overall rate of peritonitis was 0.6 episode/patient year, but after a final modification at the beginning of the third year the rate fell to 0.17, without a single case of peritonitis occurring attributable to a connection failure in 11.5 patient years. These findings show that in patients receiving continuous ambulatory peritoneal dialysis peritonitis may be prevented by enclosing the connection process and sterilising the introduced air and tubing ends.