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Audit of infection in continuous ambulatory peritoneal dialysis
A P Wilson1, G M Scott, C Lewis
1Department of Clinical Microbiology, University College Hospital, London, UK.
Abstract:
The major cause of failure of continuous ambulatory peritoneal dialysis is peritoneal or exit site infection with Staphylococcus aureus. From 1989-1992, eradication of nasal and perineal carriage, continued use of an occlusive dressing to the exit site, improved aseptic technique for dressing changes by the patient and avoidance of wetting of the dressing were used in an attempt to reduce staphylococcal infections. By comparison with the 3-year period prior to intervention, a significant increase in the life of the catheters was achieved (removed at 1 year, 13 vs. 28%, P < 0.001) with a reduction in episodes of peritonitis due to S. aureus. The study was not prospectively controlled but there did not appear to be any other factor to account for the sudden and consistent improvement observed.
Insights
Implementing infection control measures significantly reduced Staphylococcus aureus peritonitis in continuous ambulatory peritoneal dialysis patients. This intervention extended catheter survival by preventing infections, improving patient outcomes.
Area of Science:
- Nephrology
- Infectious Diseases
- Medical Devices
Background:
- Peritoneal dialysis (PD) is a vital treatment for end-stage renal disease.
- Staphylococcus aureus infections at the exit site or within the peritoneum are a major cause of PD catheter failure.
- Reducing staphylococcal infections is crucial for improving PD patient outcomes and device longevity.
Purpose of the Study:
- To evaluate the effectiveness of a multi-faceted infection control strategy in reducing Staphylococcus aureus-related peritonitis and exit site infections in PD patients.
- To assess the impact of these interventions on the functional lifespan of PD catheters.
Main Methods:
- A comprehensive infection control protocol was implemented from 1989-1992.
- Key interventions included eradicating nasal and perineal Staphylococcus aureus carriage, using occlusive dressings, improving aseptic techniques for dressing changes, and preventing dressing wetting.
- The study compared outcomes with a 3-year period prior to the intervention.
Main Results:
- A significant reduction in episodes of peritonitis caused by Staphylococcus aureus was observed.
- The functional lifespan of PD catheters significantly increased, with fewer catheters removed within the first year (13% vs. 28% in the pre-intervention period, P < 0.001).
- The observed improvements were consistent and attributed to the implemented infection control measures.
Conclusions:
- A targeted infection control strategy effectively reduces Staphylococcus aureus peritonitis and exit site infections in continuous ambulatory peritoneal dialysis patients.
- These interventions lead to a significant improvement in PD catheter survival rates.
- The findings highlight the importance of comprehensive infection prevention in maintaining the efficacy and longevity of peritoneal dialysis therapy.