Targeting COVID-19 prevention in hemodialysis facilities is associated with a drastic reduction in central venous catheter-related infections

There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

Abstract

Background

In hemodialysis (HD) patients, central venous catheter (CVC) related bloodstream infections are a major cause of morbidity and mortality. Hygienic precautions are a key aspect of dialysis care for infection prevention, but they are not sufficient to completely avoid the occurrence of CVC related infections. During the COVID-19 pandemic, hygienic precautions for preventing viral transmission have been markedly reinforced. We evaluated their effects on CVC-related infection rates.

Methods

An observational retrospective study was conducted in two hemodialysis units of the same institution treating 215 chronic hemodialysis patients, 71 of whom are currently (33%) using a CVC. In the CVC cohort, we compared data on catheter-related infection rates during the maximum spread of the COVID-19 pandemic in Italy (February to May 2020) with data from the same period of the previous year and with the whole of 2019.

Results

In 2019, we recorded a catheter-related bloodstream infection (CRBSI) rate of 1.19 (95% CI 0.81–1.68)/1000 days [2.07 (95% CI 1.12–3.52)/1000 days in the Feb-May 2019 period] and a tunnel and exit-site infection rate of 0.82 (95% CI 0.51–1.24)/1000 days [1.04 (95% CI 0.41–2.15)/1000 days in the Feb–May 2019 period]. Infection rates drastically decreased during the COVID-19 pandemic, with just one catheter-related bloodstream infection being recorded. Catheter-related bloodstream infection rates showed a significant reduction to 0.20 (95% CI 0.01–0.9)/1000 days (p < 0.05 and p < 0.005 compared to 2019 and to Feb-May 2019, respectively) and a non-significant reduction in tunnel and exit-site infections to 0.6 (95% CI 0.15–1.6)/1000 days.

Conclusions

The observed 91% reduction in catheter-related bloodstream infections compared to the same period in 2019 [IRR 0.09 (95% CI 0.002–0.64)] and the 83% reduction compared to the whole of 2019 [IRR 0.17 (95% CI 0.004–1.009)] suggest that a stricter implementation of hygienic precautions in the dialysis setting can markedly improve the problem of CVC-related infections.

Graphic abstract

Related collections

Most cited references 21

Record: found
Abstract: not found
Article: not found

Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 Update by the Infectious Diseases Society of America.

Leonard A. Mermel, Michael Allon, Emilio Bouza … (2009)

0 comments Cited 432 times – based on 0 reviews      Review now

Record: found
Abstract: found
Article: not found

Associations between hemodialysis access type and clinical outcomes: a systematic review.

Emily J Oliver, Giovanni Strippoli, Neesh I Pannu … (2013)

Clinical practice guidelines recommend an arteriovenous fistula as the preferred vascular access for hemodialysis, but quantitative associations between vascular access type and various clinical outcomes remain controversial. We performed a systematic review of cohort studies to evaluate the associations between type of vascular access (arteriovenous fistula, arteriovenous graft, and central venous catheter) and risk for death, infection, and major cardiovascular events. We searched MEDLINE, EMBASE, and article reference lists and extracted data describing study design, participants, vascular access type, clinical outcomes, and risk for bias. We identified 3965 citations, of which 67 (62 cohort studies comprising 586,337 participants) met our inclusion criteria. In a random effects meta-analysis, compared with persons with fistulas, those individuals using catheters had higher risks for all-cause mortality (risk ratio=1.53, 95% CI=1.41-1.67), fatal infections (2.12, 1.79-2.52), and cardiovascular events (1.38, 1.24-1.54). Similarly, compared with persons with grafts, those individuals using catheters had higher risks for mortality (1.38, 1.25-1.52), fatal infections (1.49, 1.15-1.93), and cardiovascular events (1.26, 1.11-1.43). Compared with persons with fistulas, those individuals with grafts had increased all-cause mortality (1.18, 1.09-1.27) and fatal infection (1.36, 1.17-1.58), but we did not detect a difference in the risk for cardiovascular events (1.07, 0.95-1.21). The risk for bias, especially selection bias, was high. In conclusion, persons using catheters for hemodialysis seem to have the highest risks for death, infections, and cardiovascular events compared with other vascular access types, and patients with usable fistulas have the lowest risk.

0 comments Cited 194 times – based on 0 reviews      Review now

Record: found
Abstract: found
Article: not found

Trends in US Vascular Access Use, Patient Preferences, and Related Practices: An Update From the US DOPPS Practice Monitor With International Comparisons.

Ronald L. Pisoni, Lindsay Zepel, Friedrich Port … (2015)

Since the bundled end-stage renal disease prospective payment system began in 2011 in the United States, some hemodialysis practices have changed substantially, raising the question of whether vascular access practice also has changed. We describe monthly US vascular access use from August 2010 to August 2013 with international comparisons, and other aspects of US vascular access practice.

0 comments Cited 92 times – based on 0 reviews      Review now

All references

Author and article information

Contributors

Maurizio Gallieni:

ORCID: http://orcid.org/0000-0002-2011-2160

maurizio.gallieni@unimi.it

Journal

Journal ID (nlm-ta): J Nephrol

Journal ID (iso-abbrev): J Nephrol

Title: Journal of Nephrology

Publisher: Springer International Publishing (Cham )

ISSN (Print): 1121-8428

ISSN (Electronic): 1724-6059

Publication date (Electronic): 28 December 2020

Publication date PMC-release: 28 December 2020

Pages: 1-9

Affiliations

[1 ]GRID grid.507997.5, ISNI 0000 0004 5984 6051, Nephrology Unit, , ASST Fatebenefratelli Sacco, ; Milano, Italy

[2 ]GRID grid.4708.b, ISNI 0000 0004 1757 2822, School of Nephrology, , Università di Milano, ; Milano, Italy

[3 ]GRID grid.5326.2, ISNI 0000 0001 1940 4177, Clinical Epidemiology and Physiopathology of Renal Diseases and Hypertension, , National Research Council (CNR), Institute of Clinical Physiology (IFC), ; Reggio Calabria, Italy

[4 ]GRID grid.4708.b, ISNI 0000 0004 1757 2822, Department of Biomedical and Clinical Sciences “Luigi Sacco”, , Università di Milano, ; via G.B. Grassi, 74, 20157 Milano, Italy

Author information

Maurizio Gallieni http://orcid.org/0000-0002-2011-2160

Article

Publisher ID: 900

DOI: 10.1007/s40620-020-00900-3

PMC ID: 7768271

PubMed ID: 33369726

SO-VID: 3a818863-2500-43ef-9250-d63aeccac96f

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

History

Date received : 25 August 2020

Date accepted : 3 November 2020

Funding

Funded by: Università degli Studi di Milano

Open Access :

Open access funding provided by Università degli Studi di Milano within the CRUI-CARE Agreement.