Brendan Smyth1,2, Sradha Kotwal1,3, Martin Gallagher1,4, Nicholas A Gray5,6, Kevan Polkinghorne7,8. 1. The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia. 2. Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia. 3. Department of Nephrology, Prince of Wales Hospital, Sydney, New South Wales, Australia. 4. Concord Clinical School, University of Sydney, Sydney, New South Wales, Australia. 5. Department of Renal Medicine, Sunshine Coast University Hospital, Sunshine Coast, Queensland, Australia. 6. Sunshine Coast Clinical School, University of Queensland, Sunshine Coast, Queensland, Australia. 7. Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia. 8. Departments of Nephrology and Medicine, Monash Medical Centre, Monash University, Melbourne, Victoria, Australia.
Abstract
AIM: Dialysis catheter-associated infections (CAI) are a serious and costly burden on patients and the health-care system. Many approaches to minimizing catheter use and infection prophylaxis are available and the practice patterns in Australia and New Zealand are not known. We aimed to describe dialysis catheter management practices in dialysis units in Australia and New Zealand. METHODS: Online survey comprising 52 questions, completed by representatives from dialysis units from both countries. RESULTS: Of 64 contacted units, 48 (75%) responded (Australia 43, New Zealand 5), representing 79% of the dialysis population in both countries. Nephrologists (including trainees) inserted non-tunnelled catheters at 60% and tunnelled catheters at 31% of units. Prophylactic antibiotics were given with catheter insertion at 21% of units. Heparin was the most common locking solution for both non-tunnelled (77%) and tunnelled catheters (69%), with antimicrobial locks being predominant only in New Zealand (80%). Eight different combinations of exit site dressing were in use, with an antibiotic patch being most common (35%). All units in New Zealand and 84% of those in Australia undertook CAI surveillance. However, only 51% of those units were able to provide a figure for their most recent rate of catheter-associated bacteraemia per 1000 catheter days. CONCLUSION: There is wide variation in current dialysis catheter management practice and CAI surveillance is suboptimal. Increased attention to the scope and quality of CAI surveillance is warranted and further evidence to guide infection prevention is required.
AIM: Dialysis catheter-associated infections (CAI) are a serious and costly burden on patients and the health-care system. Many approaches to minimizing catheter use and infection prophylaxis are available and the practice patterns in Australia and New Zealand are not known. We aimed to describe dialysis catheter management practices in dialysis units in Australia and New Zealand. METHODS: Online survey comprising 52 questions, completed by representatives from dialysis units from both countries. RESULTS: Of 64 contacted units, 48 (75%) responded (Australia 43, New Zealand 5), representing 79% of the dialysis population in both countries. Nephrologists (including trainees) inserted non-tunnelled catheters at 60% and tunnelled catheters at 31% of units. Prophylactic antibiotics were given with catheter insertion at 21% of units. Heparin was the most common locking solution for both non-tunnelled (77%) and tunnelled catheters (69%), with antimicrobial locks being predominant only in New Zealand (80%). Eight different combinations of exit site dressing were in use, with an antibiotic patch being most common (35%). All units in New Zealand and 84% of those in Australia undertook CAI surveillance. However, only 51% of those units were able to provide a figure for their most recent rate of catheter-associated bacteraemia per 1000 catheter days. CONCLUSION: There is wide variation in current dialysis catheter management practice and CAI surveillance is suboptimal. Increased attention to the scope and quality of CAI surveillance is warranted and further evidence to guide infection prevention is required.
Authors: Sradha Kotwal; Sarah Coggan; Stephen McDonald; Girish Talaulikar; Alan Cass; Stephen Jan; Kevan R Polkinghorne; Nicholas A Gray; Martin Gallagher Journal: Kidney360 Date: 2020-06-02
Authors: Kylie Martin; Yves S Poy Lorenzo; Po Yee Mia Leung; Sheri Chung; Emmet O'flaherty; Nuala Barker; Francesco Ierino Journal: Open Forum Infect Dis Date: 2020-04-11 Impact factor: 3.835
Authors: Sradha Kotwal; Alan Cass; Sarah Coggan; Nicholas A Gray; Stephen Jan; Stephen McDonald; Kevan R Polkinghorne; Kris Rogers; Girish Talaulikar; Gian Luca Di Tanna; Martin Gallagher Journal: BMJ Date: 2022-04-12