Prevention of catheter-related bloodstream infection in patients on hemodialysis
- 22 March 2011
- journal article
- review article
- Published by Springer Science and Business Media LLC in Nature Reviews Nephrology
- Vol. 7 (5), 257-265
- https://doi.org/10.1038/nrneph.2011.28
Abstract
Central venous catheters (CVCs) are frequently used as vascular access for patients who require hemodialysis, but infectious complications remain a major clinical problem. Specifically, catheter-related bloodstream infections (CRBSIs) have an adverse effect on survival, hospitalization, mortality, and the overall cost of care in this setting. The growing number of patients who require hemodialysis, combined with an increasing number of patients who cannot use any vascular access other than a CVC, stress the importance of strategies to prevent CRBSI. Various interventions aimed at reducing the incidence of CRBSI are available, but they have not yet been integrated into evidence-based, consensus guidelines. In this Review, the results from several CVC infection prevention studies-of patients from dialysis and nondialysis settings-are combined to outline a rational approach to CRBSI prevention. Prevention of intraluminal contamination of the CVC is pivotal and of proven efficacy, as are strict aseptic CVC insertion and handling protocols, use of chlorhexidine in alcohol solutions for skin cleansing, topical application of antimicrobial ointments, and antimicrobial lock solutions. Adherence to a meticulous catheter care protocol can achieve a CRBSI incidence well below one episode per 1,000 catheter days, even without the need for antimicrobial ointments or lock solutions.Keywords
This publication has 115 references indexed in Scilit:
- A Crossover Intervention Trial Evaluating the Efficacy of a Chlorhexidine-Impregnated Sponge in Reducing Catheter-Related Bloodstream Infections among Patients Undergoing HemodialysisInfection Control & Hospital Epidemiology, 2010
- Monitoring and Reducing Central Line-Associated Bloodstream Infections: A National Survey of State Hospital AssociationsAmerican Journal of Medical Quality, 2010
- Diagnosis, prevention and treatment of haemodialysis catheter-related bloodstream infections (CRBSI): a position statement of European Renal Best Practice (ERBP)Clinical Kidney Journal, 2010
- Sodium Citrate Versus Heparin Catheter Locks for Cuffed Central Venous Catheters: A Single-Center Randomized Controlled TrialAmerican Journal of Kidney Diseases, 2009
- Effect of Antimicrobial Locks for Tunneled Hemodialysis Catheters on Bloodstream Infection and Bacterial Resistance: A Quality Improvement ReportAmerican Journal of Kidney Diseases, 2009
- Increased Hemodialysis Catheter Use in Canada and Associated Mortality RiskClinical Journal of the American Society of Nephrology, 2008
- Antimicrobial Lock Solutions for the Prevention of Infections Associated with Intravascular Catheters in Patients Undergoing Hemodialysis: Systematic Review and Meta‐analysis of Randomized, Controlled TrialsClinical Infectious Diseases, 2008
- Bench-to-bedside review: Quorum sensing and the role of cell-to-cell communication during invasive bacterial infectionCritical Care, 2008
- Vascular access use in Europe and the United States: Results from the DOPPSKidney International, 2002
- Staphylococcus aureusNasal Carriage and Infection in Patients on HemodialysisNew England Journal of Medicine, 1986