Hostname: page-component-cd9895bd7-dk4vv Total loading time: 0 Render date: 2024-12-23T04:46:52.125Z Has data issue: false hasContentIssue false
  • English
  • Français

Retrospective Analysis of Catheter-Related Infections in a Hemodialysis Unit

Published online by Cambridge University Press:  21 June 2016

Linda A. Colville  and
Andy H. Lee
Linda A. Colville
Affiliation:
School of Public Health, Curtin University of Technology, Perth, Australia
Andy H. Lee*
Affiliation:
School of Public Health, Curtin University of Technology, Perth, Australia
*
Department of Epidemiology and Biostatistics, School of Public Health, Curtin University of Technology, GPO Box U 1987, Perth, WA 6845, Australia, ([email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective.

To compare the incidence rates of catheter-related bloodstream infection associated with different vascular access methods in patients receiving hemodialysis.

Setting.

Tertiary care public hospital in Western Australia.

Design.

Retrospective analysis of surveillance data collected by the hospital's infection control department.

Methods.

The number of confirmed bloodstream infections for each type of vascular access was identified for the period from July 2002 through June 2003. The corresponding number of patient-days was determined to calculate the infection incidence rates. The serially correlated data were then analyzed using Poisson generalized estimating equations.

Results.

A total of 32 confirmed bloodstream infections were identified. Infection rates, in number of infections per 1,000 patient-days, were as follows: 0.4 for native arteriovenous fistulae; 2.86 for synthetic arteriovenous grafts; 4.02 for permanent, tunneled, cuffed central venous catheters; and 20.2 for temporary, nontunneled, noncuffed central venous catheters. Compared with permanent catheters, the monthly infection rate associated with the temporary catheters was significantly higher (incident rate ratio [IRR], 5.025 [95% confidence interval {CI}, 1.532-16.484]; P = .008) and that of arteriovenous fistulae was significantly lower (IRR, 0.099 [95% CI, 0.030-0.324]; P = .001). The monthly infection rate for arteriovenous grafts was not significantly different from that for permanent central venous catheters (IRR, 0.702 [95% CI, 0.246-2.008]; P = .510).

Conclusions.

A hierarchy of infection risk associated with vascular access type is evident. Native arteriovenous fistulae should be recommended for all patients receiving chronic hemodialysis, to minimize infection.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 27 , Issue 9 , September 2006 , pp. 969 - 973
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2006

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Tokars, JI, Miller, ER, Stein, G. New national surveillance system for hemodialysis-associated infections: initial results. Am J Infect Control 2002; 30:288–295.CrossRefGoogle ScholarPubMed
2.Canaud, B. Haemo-dialysis related infection: time for action. Nephrol Dial Transplant 1999; 14:2288–2290.Google Scholar
3.Stevenson, KB, Adcox, MJ, Mallea, MC, Narasimhan, N, Wagnild, JP. Standardized surveillance of hemodialysis vascular access infections: 18-month experience at an outpatient, multi facility hemodialysis center. Infect Control Hosp Epidemiol 2000; 21:200–203.CrossRefGoogle Scholar
4.Price, CS, Hacek, D, Noskin, GA, Peterson, L. An outbreak of bloodstream infections in an outpatient hemodialysis centre. Infect Control Hosp Epidemiol 2002; 23:725–729.Google Scholar
5.Dopirak, M, Hill, C, Oleksiw, M, et al. Surveillance of hemodialysis-associated primary blood stream infection: the experience of ten hospital based centers. Infect Control Hosp Epidemiol 2002; 23:721–724.Google Scholar
6.Taylor, G, Gravel, D, Johnston, L, Embil, J, Holton, D, Paton, S. Prospective surveillance for primary bloodstream infections occurring in Canadian hemodialysis units. Infect Control Hosp Epidemiol 2002; 23:716–722.Google Scholar
7.Blakestijn, PJ. Treatment and prevention of catheter-related infections in haemodialysis patients. Nephrol Dial Transplant 2001; 16:1975–1978.Google Scholar
8.Caring for Australians with Renal Impairment (The CARI Guidelines 1999). Managing Infections in Vascular Access. New South Wales, Australia; Westmead, 1999.Google Scholar
9.Dogra, GK, Herson, H, Hutchison, B, et al. Prevention of tunneled hemodialysis catheter-related infections using catheter-restricted filling with gentamicin and citrate: a randomized controlled study. J Am Soc Nephrol 2002; 13:2133–2139.Google Scholar
10.Australian Infection Control Association. Blood Stream Infection. Eight Mile Plains; 2003. Available at: http://www.safetyandquality.org/bsidefinejun05.pdf. Accessed August 21, 2006.Google Scholar
11.Stata [computer program]. Release 8. College Station, TX: Stata; 2003.Google Scholar
12.Hardin, JW, Hilbe, JM. Generalized Estimating Equations. Boca Raton, FL: Chapman & Hall/CRC; 2002.Google Scholar