Hemodialysis Infection Prevention Using Polysporin Ointment With Shower Technique in Satellite Centres Pilot Study

Launched by UNIVERSITY HEALTH NETWORK, TORONTO · Nov 28, 2013

Keywords

ClinConnect Summary

CVC related infections are associated with increased morbidity and hospitalization rates, high treatment costs, and poor survival compared to use of an arteriovenous access. To prevent infection, patients should preserve the integrity and dryness of their CVC dressings. Showering should be avoided, as it is difficult to attain full protective coverage of the exit site using dressings and barriers. Wet dressings place patients at increased infection risk, especially if their CVC exit site is not fully healed. However, in a survey of 274 CVC dependent HD patients, 64% indicated that the recom...

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Eligibility criteria

• • Inclusion Criteria
• • Informed written consent obtained (English speaking)
• • Age \>18 years
• • Requires a CVC as the vascular access: a) end stage kidney disease without a functioning surgically created access; b) end stage kidney disease whose peritoneal dialysis problems require transfer to HD for an anticipated prolonged period
• • Passed 2/3 tests of CVC exit site healing (see below)
• • Must be willing and able to take a shower as the standard form of body cleansing if randomized to STP
• • Trisodium citrate (4%) as standard CVC locking solution
• • CVC has been in situ for \> 6 weeks
• • Exclusion criteria
• • Acute kidney failure, likely to be reversible with recovery of renal function
• • Non-Tunneled CVC
• • Antibiotic use by any route in the week prior to enrolling in the study, including intranasal mupirocin
• • On immunosuppressant therapy
• • Use of the CVC for purposes other than access for hemodialysis
• • Involvement in another interventional study related to their vascular access
• • CVC or patient life expectancy \<6 months (e.g. active malignancy; serious comorbidity such as hepatic failure)
• • Routine use of tissue plasminogen activator or antibiotic as a locking solution
• • CVC insertion in location other than the neck/chest region (IJ or subclavian acceptable)