Prevention of hemodialysis CRBSI
Abstract:
Rationale & objective: Central venous catheters (CVCs) are widely used for hemodialysis but are prone to burdensome and costly bloodstream infections. We aimed to determine whether multifaceted quality improvement interventions in hemodialysis units can prevent hemodialysis catheter-related bloodstream infections (HDCRBSI).
Study design: Systematic review.
Setting & study populations: People receiving hemodialysis via a CVC outside of intensive care units (ICU).
Selection criteria for studies: PubMed, EMBASE, and CENTRAL were searched from inception to 23 April 2022 to identify randomized trials, time series analyses, and before-after studies examining the effect of multifaceted interventions on the incidence of HDCRBSI or access-related bloodstream infections (ARBSI) compared to usual care.
Data extraction: Two people independently extracted data and assessed the risk of bias and quality of evidence using validated tools.
Analytical approach: Intervention effects, validity, and characteristics of studies with the same design were compared. Differences between study designs were described.
Results: We included 21 studies from among 8824 identified from our search. Among 15 studies that measured HDCRBSI, 2 methodologically heterogenous cluster randomized trials reported discordant intervention effects, 2 interrupted time series analyses reported favorable interventions with discordant patterns of effect, and 11 before-after studies reported favorable interventions with a very high risk of bias. Among 6 studies that only measured ARBSI, 1 time series analysis and 1 before-after study did not find a favorable intervention effect, while 4 before-after studies reported a favorable effect with a very high risk of bias. The overall quality of evidence was low for HDCRBSI and very low for ARBSI.
Limitations: Nine definitions of HDCRBSI were used. Ten studies included hospital-based and satellite facilities but did not report separate intervention effects for each type of facility.
Conclusions: Multifaceted quality improvement interventions may prevent HDCRBSI outside the ICU. However, evidence supporting them is of low quality and further carefully conducted studies are warranted.
Reference:
Lazarus B, Bongetti E, Ling J, Gallagher M, Kotwal S, Polkinghorne KR. Multifaceted Quality Improvement Interventions to Prevent Hemodialysis Catheter-Related Bloodstream Infections: A Systematic Review. Am J Kidney Dis. 2023 May 11:S0272-6386(23)00613-3. doi: 10.1053/j.ajkd.2023.02.006. Epub ahead of print. PMID: 37178814.