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An advisory board in December 2020 brought together doctors and nurses from Europe and the US with the objective of understanding current practice in the prevention and management of central line-associated bloodstream infections ( CLABSIs ) in relation to haemodialysis catheters . Participants discussed and evaluated the ClearGuard TM HD antimicrobial barrier caps value proposition and shared practical benefits and potential barriers to using ClearGuard HD .
Note : the list of abbreviations used in this report is to be found in Box 1 .
Central venous catheters ( CVCs ) are used for haemodialysis whenever a patient does not have another form of access . Ideally patients do not continue with CVCs for very long , but this can vary on a case-by-case basis . Approximately 15 – 38 % of patients receiving haemodialysis in European hospitals use a CVC and 10 – 30 % of those patients are still using the CVC after one year . With continued use comes the potential complication of infection .
The pandemic has caused significant upheaval for the healthcare industry and it is impossible to ignore the impact COVID-19 has had on the way we approach general hygienic practices . More than ever , it has become essential to keep hospitalisation rates down . One attendee pointed out how well CLABSI prevention fits into the current hygiene priorities . The goal is to keep patients out of the hospitals and by preventing catheter infections , we also help minimise the risk of COVID infection .
Infection in the haemodialysis unit In Western Europe , approximately 30 % of ICU patients are affected by at least one episode of a healthcare-acquired infection ( WHO report 2011 ). Using standard caps , microbes can enter the catheter and form a biofilm that migrates down the catheter and enter directly into the bloodstream , where they can cause a systemic bloodstream infection . These complications can be , as one attendee put it , “ catastrophic ” and “ disastrous ”. Prevention and management of CLABSIs are critical in the treatment of haemodialysis patients due to substantial morbidity , mortality and financial costs .
Across the board , meeting attendees agreed that the safety of the patient is paramount . Yet not all regions and institutions actively track and monitor CLABSI infection rates . Several attendees cited the existence of departmental , regional , or national databases but noted that not all clinics utilise them or that the data were not shared on a regular basis to a wider audience . In the US , infection rates are published for any dialysis patient to look up . So , they can search for another dialysis unit if they do not like what they see .
This is not the case in Germany . There they do not have an established national tracking system ; some dialysis units may track themselves , but so far , it is not mandatory .
Understanding the baseline levels of infection is essential to fully understand the extent of the infection problem . Keeping a constant pulse on infection rates is key ; knowing where we >
BOX 1
Abbreviations
The risk to an individual is potentially high and could be fatal Marlies Ostermann
AJKD ASN CLABSI CRRT CVC EDTNA ERA-EDTA
JASN KDIGO KDOQI MTG NICE NKF PBC SLEDD
American Journal of Kidney Diseases American Society of Nephrology Central line-associated bloodstream infection Continuous renal replacement therapy Central venous catheter European Dialysis and Transplant Nurses Association European Renal Association – European Dialysis and Transplant Association Journal of the American Society of Nephrology Kidney Disease Improving Global Outcome Kidney Disease Outcomes Quality Initiative Medical Technologies Guidance The National Institute for Health and Care Excellence National Kidney Foundation Positive blood culture Sustained low-efficiency daily diafiltration