4 | HAEMODIALYSIS PATIENTS IN EUROPE | 2021
I believe that prevention is the key Alirio Martinho Belichior currently stand is the only way we can monitor if things are trending in a direction we don ’ t want to go .
Keeping infection rates low – protocols and guidelines Having a dedicated haemodialysis catheter team or standardised catheter care protocols in place can provide several benefits across the board . First and foremost , the patient benefits due to lower rates of complications and infections . A dedicated team helps maintain quality standards as they can build protocols , procedures , stay on top of the latest references and guidelines , and keep tabs on potential issues , ensuring top-notch care for the patient . Standard protocols also garner a level of trust between patient and caregiver . Patients notice if someone does something in a different order ( they go through the process multiple times a week ). When a patient sees that each time , the process is performed the same way and they do not have complications , it builds trust .
Guidelines can vary by country , but most Faculty noted that they were familiar with various national and international guidelines as most institutions seem to develop in-house procedures that incorporate information from a variety of sources .
Although a US-based guideline , several attendees cited knowledge of , and the impact of , the Kidney Disease Outcomes Quality Initiative ( KDOQI ) guidelines . Now , KDOQI is taking a back seat and professionals are starting to look more to Kidney Disease Improving Global Outcome ( KDIGO ) guidelines .
However , one attendee pointed out that , to their knowledge , KDIGO does not contain any central catheter guidelines thus far .
Some national guidelines , such as the National Institute for Health and Care Excellence ( NICE ) guidelines in the UK , are mandatory to follow . Hospitals are able to opt out only if they have given sufficient reasons .
If provided with convincing data , NICE will publish guidelines to address high-risk areas or areas with significant clinical variations . In addition to clinical practices , NICE also addresses medical devices and can mandate or prohibit recommendation of specific devices .
Comprehensive protocols can and should always improve to help prevent infections that are preventable . All European associations are trying to find the best solution possible . However , guidelines are only the first step . As one attendee pointed out , the next step is how to translate them into daily work .
Cost of infection prevention and management Everyone aims for zero infection , but this obviously comes at a cost . So , the quandary is , what is an acceptable cost of infection prevention ? Any prevention protocol or care bundle will reduce infection rates and decrease the cost of infection management in the long term . Yet there remain discrepancies among professionals and across hospitals as to what constitutes an acceptable cost .
Quantifying the cost of infection prevention is theoretically more straightforward than for infection management as you can more easily enumerate and measure precautions along with their related costs . As they know exactly what is needed for prevention , they can calculate how much it will cost .
With infection management , there are so many variables and unknowns in quantifying the cost of management that it becomes difficult to accurately compare financially . It can depend on the patient , the comorbidities , and the complications . The cost per catheter infection in the US is estimated to be anywhere between $ 30,000 and $ 60,000 USD . CLABSIs are very expensive , with an estimated additional length of stay of 4 – 14 days and additional costs per episode of € 4200 –€ 13,030 in European countries ( Report on the Burden of Endemic Health Care-Associated Infection Worldwide , World Health Organization 2011 ).
Indirect costs come in many forms including re-hospitalisation , procedures performed in other departments , staff and patient training , financial penalties , and even cost to the reputation of the institution . In addition to the material costs , there is also an emotional cost to the patient and their relatives , which is difficult to count and to assign value .
One Faculty stated that too much emphasis is placed on the costly ‘ fire-fighting ’ treatment rather than on cost-effective prevention . Prevention is sometimes perceived as very costly as the cost is immediate , but the outcomes take time . Most attendees agreed that prevention would be more profitable in the longer term .
ClearGuard HD antimicrobial barrier caps When using standard caps , even with a lot of the scrub-the-hub kind of procedures , only the outside area of the catheter hub is cleaned , and the inner aspect of the catheter hub is not addressed , leaving the possibility for catheter infections .
The ClearGuard HD antimicrobial barrier cap is the first and only device that has been clinically proven to reduce the rate of bloodstream infection in patients with haemodialysis catheters . It was first cleared by the US Food and Drug Administration for use with haemodialysis catheters in 2013 , and in 2018 the clearance was broadened to include a reduction in the incidence of CLABSIs in haemodialysis patients with CVCs . ( See Box 2 for key supporting publication data and Box 3 for real-world application of its use .)
The threads and rod of these caps are coated