DIALYSIS CATHETER INFECTION (Atena Editora)

Abstract

Annually, the number of patients on hemodialysis in Brazil and in the world grows, mainly with the increasing number of cases of Arterial Hypertension, Diabetes and Obesity, resulting from the demographic transition. Avoiding the catheter is the obvious best strategy to reduce episodes of bloodstream infection. Interventions such as early referral of patients to nephrologists, multidisciplinary teams, and vascular access coordinators who provide patient education; implantation of arteriovenous grafts for early cannulation for hemodialysis; and urgent-onset peritoneal dialysis have been shown to be effective in decreasing catheter use. New interventions for prophylaxis of catheter-associated bloodstream infection include the following: (1) clear chlorhexidine-impregnated exit site dressing; (2) a chlorhexidine coated stem hub device; and (3) an antimicrobial, preferably antibiotic-free, lock. There may be an important and underused role for S. aureus nasal decolonization protocols with mupirocin for hemodialysis patients. A combination of these interventions may be ideal. Finally, identifying barriers to safe practices in the hemodialysis setting, using human factors systems engineering, will undoubtedly prove invaluable in reducing infections in the future.