Prevention of infectious complications in peritoneal dialysis: best demonstrated practices

Abstract

Peritoneal dialysis (PD) related infections continue to be a serious complication for PD patients. Peritonitis can be associated with pain, hospitalization and catheter loss as well as a risk of death. Peritonitis risk is not evenly spread across the PD population or programs. Very low rates of peritonitis in a program are possible if close attention is paid to the causes of peritonitis and protocols implemented to reduce the risk of infection. Protocols to decrease infection risk in PD patients include proper catheter placement, exit-site care that includes Staphylococcus aureus prophylaxis, careful training of patients with periodic retraining, treatment of contamination, and prevention of procedure-related and fungal peritonitis. Extensive data have been published on the use of antibiotic prophylaxis to prevent exit site infections. There are fewer data on training methods of patients to prevent infection risk. Quality improvement programs with continuous monitoring of infections, both of the catheter exit site and peritonitis, are important to decrease the PD related infections in PD programs. Continuous review of every episode of infection to determine the root cause of the event should be routine in PD programs. Further research is needed examining approaches to decrease infection risk.

ISPD Catheter-Related Infection Recommendations: 2017 Update

“…The method of training is often believed to affect the risk of catheter-related infections (79,80). An observational study found that the rate of ESI was reduced 10-fold with a program that incorporated intensive training of nursing staff and patients, improved operative aseptic technique and reduction in S. aureus nasal carriage (81).…”

ISPD Position Statement on Reducing the Risks of Peritoneal Dialysis–Related Infections

“…No randomized trials have compared different training schedules that cover the same content and curriculum. (36). Patients need to come to the center for a tubing change if the end of the tubing is contaminated.…”

Long-term efficacy of intermittent peritoneal dialysis using various doses

“…Peritonitis is one of the key causes resulting in withdraw from PD (11). The peritoneum has the potent ability of self-repair.…”