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Related Experiment Videos

Exit-site care--is it time for a change?

B J Hasbargen1, D J Rodgers, J A Hasbargen

  • 1Department of Medicine, Fitzsimons Army Medical Center, Aurora, Colorado 80045-5001.

Peritoneal Dialysis International : Journal of the International Society for Peritoneal Dialysis
|January 1, 1993
PubMed
Summary
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Implementing a new cleansing agent, CC-500, significantly reduced peritoneal catheter exit-site infections (ESI's) from 0.76 to 0.12 episodes/patient-year. This highlights the importance of monitoring quality improvement indicators for patient care.

Area of Science:

  • Nephrology
  • Infectious Diseases
  • Medical Quality Improvement

Background:

  • Peritoneal catheter exit-site infections (ESI's) are a significant cause of morbidity and reduced catheter longevity.
  • Existing protocols for daily exit-site care, including cleansing agents and dressings, lacked standardization and efficacy.
  • Povidone iodine, a common antiseptic, can irritate the skin, potentially increasing infection risk.

Purpose of the Study:

  • To evaluate the impact of a modified exit-site care protocol on the incidence of ESI's.
  • To assess the effectiveness of a new gentle antibacterial cleaner (CC-500) in reducing ESI's.
  • To demonstrate the utility of prospective monitoring within a quality improvement program.

Main Methods:

  • The study prospectively monitored ESI's as part of a quality improvement program.

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  • The exit-site care protocol was modified to include daily showers with CC-500, a gentle antibacterial cleaner.
  • The use of hydrogen peroxide and dressings remained consistent, and a protocol for traumatized exit sites was introduced.

    • Main Results:

    • The incidence of ESI's decreased significantly from 0.76 episodes/patient-year to 0.12 episodes/patient-year.
    • This reduction was observed in a small patient population (n=18) after protocol modification.
    • The modified protocol demonstrated a substantial improvement in infection rates.

    Conclusions:

    • Switching to CC-500 as the primary cleansing agent for peritoneal catheter exit sites can significantly reduce infection rates.
    • Prospective monitoring of quality improvement indicators is crucial for identifying effective changes in patient care protocols.
    • The findings suggest that a gentle antibacterial cleaner may be more effective and less irritating than traditional antiseptics for ESI prevention.