Vascular access and infection prevention and control: a national survey of routine practices in Irish haemodialysis units

Abstract

BackgroundNational and international guidelines recommend the use of effective vascular access (VA) and infection prevention and control practices within the haemodialysis environment. Establishing an arterio-venous fistula (AVF) and preventing central venous catheter (CVC)-related infections are ongoing challenges for all dialysis settings. We surveyed VA and routine infection prevention and control practices in dialysis units, to provide national data on these practices in Ireland.MethodsA descriptive survey was emailed to nurse managers at all adult (n = 19) and children (n = 1) outpatient haemodialysis units in the Republic of Ireland. Data collected included AVF formation, CVC insertion and maintenance practices, VA use and surveillance of infection and screening protocols. Nineteen of the 20 units responded to the survey.ResultsThe AVF prevalence was 49% for 1370 patients in 17 units who provided these data [mean prevalence per unit: 45.7% (SD 16.2)]; the CVC mean prevalence per unit was 52.5% (SD 16.0). Fourteen dialysis units experienced inadequate access to vascular surgical procedures either due to a lack of dedicated theatre time or hospital beds. Six units administered intravenous prophylactic antimicrobials prior to CVC insertion with only two units using a CVC insertion checklist at the time of catheter insertion.ConclusionIn general, dialysis units in Ireland show a strong adherence to national guidelines. Compared with the 12 countries participating in the Dialysis Outcomes Practice Patterns Study (DOPPS 4), in 2010, AVF prevalence in Irish dialysis units is the second lowest. Recommendations include establishing an AVF national prevalence target rate, discontinuing the administration of intravenous prophylactic antimicrobials prior to CVC insertion and promoting the use of CVC insertion checklists.

Prevalence and Correlates of Central Venous Catheter Use Among Haemodialysis Patients in the Irish Health System - A National Study

“…The fistula first initiative in the US is an excellent example where national policy underpinned by a strong regulatory framework has led a significant increase in AVF use and overall reduction in CVC [26][27][28]. In Ireland, McCann and colleagues reported a CVC prevalence of 52% in 2011 from results of a national survey of vascular access [20]. A direct comparison with our results 5 years later, highlight similar prevalence, suggesting that little has changed.…”

Prevalence and correlates of central venous catheter use among haemodialysis patients in the Irish health system - a national study

“…The fistula first initiative in the US is an excellent example where national policy underpinned by a strong regulatory framework has led a significant increase in AVF use and overall reduction in CVC [ 26 – 28 ]. In Ireland, McCann and colleagues reported a CVC prevalence of 52% in 2011 from results of a national survey of vascular access [ 20 ]. A direct comparison with our results 5 years later, highlight similar prevalence, suggesting that little has changed.…”

“…The structure, organisation, and delivery of HD vascular access care is a complex process and requires multidisciplinary team engagement with defined care pathways and embedded quality assurance. The survey by McCann et al identified a number of deficits in the health system including lack of availability of elective surgical beds and operating room slots, insufficient vascular access coordinators and access protocols which are likely to impact the timely and effective creation of AVFs [ 20 ]. Physician perspectives, as well as availability and experience of a vascular surgeon may also play a role.…”

“…National data on the epidemiology of vascular access (VA) is lacking within the Irish health system, which may hamper strategic decision-making on the organisation and delivery of optimal vascular access care. A recent cross-sectional study by McCann et al found that the prevalence of tunnelled dialysis catheters across Irish dialysis centres was 52%, ranging from 35 to 80% across participating centres [ 20 ]. The survey identified deficiencies in the organisation and delivery of vascular access provision including lack of dedicated theatre time for vascular surgery as contributing factors.…”

Determinants and outcomes of access-related blood-stream infections among Irish haemodialysis patients; a cohort study

“…National and international guidelines along with national policy initiatives [6–9] recommend the use of arteriovenous fistula (AVF) whenever possible, as the risk of infections and other complications is highest among patients using central venous catheters (CVCs) [3, 10, 11]. Despite the dangers associated with CVC use, these devices remain the principal type of access in the majority of HD patients in Ireland [12, 13] and internationally [14].…”