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

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.
• 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.