Prevention of Central Line–Associated Bloodstream Infections in Hemodialysis Patients

Abstract

An increasing proportion of central line-associated bloodstream infections (CLABSIs) are seen in outpatient settings. Many of such infections are due to hemodialysis catheters (HD-CLABSIs). Such infections are associated with substantial morbidity, mortality, and excess healthcare costs. Patients who receive dialysis through a catheter are 2-3 times more likely to be hospitalized for infection and to die of septic complications than dialysis patients with grafts or fistulas. Prevention measures include minimizing the use of hemodialysis catheters, use of CLABSI prevention bundles for line insertion and maintenance, and application of antimicrobial ointment to the catheter exit site. Instillation into dialysis catheters of antimicrobial solutions that remain in the catheter lumen between dialyses (antimicrobial lock solutions) has been studied, but it is not yet standard practice in some dialysis units. At least 34 studies have evaluated the impact of antimicrobial lock solutions on HD-CLABSI rates. Thirty-two (94%) of the 34 studies demonstrated reductions in HD-CLABSI rates among patients treated with antimicrobial lock solutions. Recent multicenter randomized controlled trials demonstrated that the use of such solutions resulted in significantly lower HD-CLABSI rates, even though such rates were low in control groups. The available evidence supports more routine use of antimicrobial lock solutions as an HD-CLABSI prevention measure in hemodialysis units.

Antibodies to PhnD Inhibit Staphylococcal Biofilms

“…In addition to the significant patient morbidity associated with these infections, direct medical costs are approximately $20,000 per occurrence (2,3). As such, prevention of CLABSI has been declared a United States health care priority (4).…”

Reducing Catheter-Related Infections in Hemodialysis Patients

“…Boyce recently reviewed all antimicrobial lock studies (antibiotic-and non-antibiotic-based) performed from 1999 to 2012 and concluded that antimicrobial locks should be used for CRBSI prevention in all hemodialysis units (11). In addition, five meta-analyses or systematic reviews (12)(13)(14)(15)(16) published during this time period indicate significant reductions in CRBSI; in particular, two meta-analyses reported a number needed to treat to prevent one CRBSI of 3 to 4 (12,13).…”

Maintaining Safety in the Dialysis Facility

“…Some CVCs specify in their package insert instructions for use that the polymers used are broken down by some ointments or solutions and should not be used. Antibiotic and nonantibiotic antimicrobial lock solutions have proven effective in reducing infections (54)(55)(56)(57). A standard approach to catheter care, defined by facility policy and verified by practice audits, will likely result in fewer CVC-associated bloodstream infections.…”