Applying endoluminal catheter colonization surveillance cultures in renal dialysis unit - an effort to reduce CRBSI rate

Abstract

Catheter related blood stream infection (CRBSI) is a common complication with the use of central venous catheters (CVC) in hemodialysis patients. The study was designed to evaluate the effect of implementation of surveillance cultures (SCs) on the rate of CRBSIs. Method: This prospective cohort study was done over a period of 6 months on hemodialysis patients with internal jugular vein catheters. Catheter related blood stream infection rates (BSI) were measured and compared in the 2 included groups, the study group (15 patients) and the control group (15 patients). In both groups, conventional infection prevention and control measures were applied. Patients in the study group were checked for intraluminal microbial colonization every 2 weeks by SCs. According to SCs results, patients were classified into 4 groups, then according to the group they were managed with antibiotic lock therapy (ALT) with or without systemic antibiotics. Results: Of the collected 140 SCs from the study group, 108 (77%) were negative and 32 (23%) were positive. Eighteen cases in groups 2 & 3 received ALT and 6 patients in group 4 received ALT and systemic antibiotic. SCs succeed to eliminate intraluminal microbial colonization in all positive cases except for 1 case in group 2 and 3 cases in group 4. The CRBSI rate was 2.14 per 1,000 catheter days in the study group compared to 5.57 per 1,000 catheter days in the control group (P=0.037). Conclusion: This study shows that the implementation of periodic SCs is associated with a significant reduction in the CRBSI rates in hemodialysis patients.