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BOX 2
Key publications
• ClearGuard HD caps versus standard CVC caps
• 12-month prospective cluster-randomised multicentre open-label comparative effectiveness trial
• 2470 patients ( 1245 treatment and 1225 control ) accruing 346,946 CVC days
• 40 centres in the United States
• Primary endpoint was PBC rate as an indicator of the BSI rate
• ClearGuard caps were associated with 56 % lower BSI rate versus the use of standard caps
• ClearGuard HD caps versus Tego connector with a Curos cap
• 13-month prospective cluster-randomised multicentre open-label comparative effectiveness trial
• 1671 patients ( 826 treatment and 845 control ) accruing 183,106 CVC days
• 40 centres in the United States
• Primary endpoint was PBC rate as indicator of the BSI rate
• ClearGuard caps were associated with a 63 % lower BSI rate versus the use of Tego with Curos
We all know that people die of catheter infections and how can you tie a cost to that ? Connie Jo Hemeyer with chlorhexidine ( broad-spectrum antimicrobial agent ). On insertion of the barrier cap , the rod extends into the liquid-filled haemodialysis catheter hub where the antimicrobial coating dissolves , killing microorganisms .
Chlorhexidine acetate is dry coated on the cap , packaged and sterilised . When the rod is inserted into the locking solution in the catheter hub , the chlorhexidine is activated . No special solution is required and ClearGuard has been shown to work with saline , heparin and citrate .
These single-use caps have a three-year shelf-life and can be used in short- or long-term haemodialysis catheters . They can be used with essentially any haemodialysis catheter hub including CRRT and SLEDD .
Over 300 hospitals and 3500 dialysis clinics in the US are already using ClearGuard caps . It is used in the ICU , in outpatients , and has even been used for home dialysis care . Current starting cost is $ 6 ( USD ) per pair . ClearGuard HD was launched in France , the UK , Spain and Germany in January 2021 .
ClearGuard HD antimicrobial barrier caps have been recommended in the National Kidney Foundation ( NKF ) KDOQI Clinical Practice Guideline for Vascular Access .
Uptake of new technologies Implementing change in an institution can sometimes prove difficult ; each institution typically has its own procedures in place for bringing new technologies into general
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BOX 3
Real-world experience
Connie Jo Hemeyer ( Mayo Clinic , US ) briefly described how she effected change in her institution with a trial of ClearGuard HD , extrapolating data from a single dialysis unit quality improvement study to global dialysis systems .
She started with just one dialysis unit , to see what change could be observed .
In just her outpatient dialysis unit alone with 65 – 70 patients , she has had zero infections since starting use of ClearGuard HD caps .
She took the data from the quality improvement project forward to the global dialysis systems and decided after that one little project that they would implement it across the institution .
She indicated that they are in the process of collecting that data for publication and will hopefully presenting it in the next year .
MS supported the idea and recommended presenting it at ERA-EDTA to help raise awareness in Europe .