Meg Jardine1,2, Robert J Commons3, Janak R de Zoysa4,5, Muh G Wong1,6,7, Nicole Gilroy7,8, Julianne Green8, Belinda Henderson9, Rhonda L Stuart10,11, David J Tunnicliffe12,13, Carolyn van Eps14, Eugene Athan15. 1. Renal and Metabolic Division, The George Institute for Global Health, University of NSW, Sydney, New South Wales, Australia. 2. Nephrology Unit, Concord Repatriation General Hospital, Sydney, New South Wales, Australia. 3. Menzies School of Health Research and Charles Darwin University, Casuarina, Northern Territory, Australia. 4. Renal Services, North Shore Hospital, Auckland, New Zealand. 5. Faculty of Medicine and Health Sciences, The University of Auckland, Auckland, New Zealand. 6. Department of Renal Medicine, Royal North Shore Hospital, Sydney, New South Wales, Australia. 7. Sydney Adventist Hospital, Sydney, New South Wales, Australia. 8. Department of Infectious Diseases, Westmead Hospital, Sydney, New South Wales, Australia. 9. Department of Infectious Diseases, Princess Alexandra Hospital, Brisbane, Queensland, Australia. 10. Monash Infectious Diseases, Monash Health, Melbourne, Victoria, Australia. 11. Department of Medicine, Monash University, Melbourne, Victoria, Australia. 12. Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia. 13. Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, New South Wales, Australia. 14. Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia. 15. Department of Infectious Diseases, Barwon Health, Deakin University, Geelong, Victoria, Australia.
Abstract
AIM: There is no national consensus on infection control in haemodialysis units in Australia and New Zealand. The primary aim of this guideline was to provide recommendations on screening for blood-borne viruses and multi-resistant organisms for dialysis units based on the available evidence. METHODS: The Kidney Health Australia Caring for Australasians with Renal Impairment guidelines, overall approach to guideline development follows the GRADE framework. A facilitated workshop was conducted to ensure that patient and caregiver concerns were considered. The evidence from relevant medical databases on the impact of screening on detection and transmission rates, hospitalization, mortality and psychosocial care, was reviewed and critically appraised. The guideline group made recommendations from the evidence available. RESULTS: The main guideline recommendations are: Dialysis units adopt a comprehensive approach that encompasses standard infection control precautions. Conduct routine surveillance for key blood-borne viruses and methicillin-resistant Staphylococcus aureus. Conduct routine surveillance of individual levels of protection against hepatitis B for patients on haemodialysis. Use dedicated dialysis machines for HBV-infected patients. The evidence in totality was not found to support routine surveillance of vancomycin-resistant Enterococci . Enhanced surveillance in light of the local risk of transmittable infectious agents should be considered by dialysis units. Very few studies have reported on the potential adverse effects of screening and associated practices. CONCLUSIONS: Future research should focus on the potential benefits and adverse effects of screening and associated practices on clinical outcomes including infections prevented and health service delivery, and psychosocial domains for patients. Given the results of trials in the critical setting, the effectiveness of methicillin-resistant Staphylococcus aureus decolonization in people receiving dialysis therapy warrants further research.
AIM: There is no national consensus on infection control in haemodialysis units in Australia and New Zealand. The primary aim of this guideline was to provide recommendations on screening for blood-borne viruses and multi-resistant organisms for dialysis units based on the available evidence. METHODS: The Kidney Health Australia Caring for Australasians with Renal Impairment guidelines, overall approach to guideline development follows the GRADE framework. A facilitated workshop was conducted to ensure that patient and caregiver concerns were considered. The evidence from relevant medical databases on the impact of screening on detection and transmission rates, hospitalization, mortality and psychosocial care, was reviewed and critically appraised. The guideline group made recommendations from the evidence available. RESULTS: The main guideline recommendations are: Dialysis units adopt a comprehensive approach that encompasses standard infection control precautions. Conduct routine surveillance for key blood-borne viruses and methicillin-resistant Staphylococcus aureus. Conduct routine surveillance of individual levels of protection against hepatitis B for patients on haemodialysis. Use dedicated dialysis machines for HBV-infectedpatients. The evidence in totality was not found to support routine surveillance of vancomycin-resistant Enterococci . Enhanced surveillance in light of the local risk of transmittable infectious agents should be considered by dialysis units. Very few studies have reported on the potential adverse effects of screening and associated practices. CONCLUSIONS: Future research should focus on the potential benefits and adverse effects of screening and associated practices on clinical outcomes including infections prevented and health service delivery, and psychosocial domains for patients. Given the results of trials in the critical setting, the effectiveness of methicillin-resistant Staphylococcus aureus decolonization in people receiving dialysis therapy warrants further research.
Authors: Laura Sola; Nathan W Levin; David W Johnson; Roberto Pecoits-Filho; Harith M Aljubori; Yuqing Chen; Stefaan Claus; Allan Collins; Brett Cullis; John Feehally; Paul N Harden; Mohamed H Hassan; Fuad Ibhais; Kamyar Kalantar-Zadeh; Adeera Levin; Abdulkarim Saleh; Daneil Schneditz; Irma Tchokhonelidze; Rumeyza Turan Kazancioglu; Ahmed Twahir; Robert Walker; Anthony J O Were; Xueqing Yu; Fredric O Finkelstein Journal: Kidney Int Suppl (2011) Date: 2020-02-19
Authors: Deborah C Holt; Tegan M Harris; Jaquelyne T Hughes; Rachael Lilliebridge; David Croker; Sian Graham; Heather Hall; Judith Wilson; Steven Y C Tong; Phillip M Giffard Journal: PLoS One Date: 2021-02-05 Impact factor: 3.240