In Germany, approximately 100,000 people are permanently dependent on dialysis due to chronic kidney failure [1]. As these patients require vascular access for haemodialysis - usually in the form of an arteriovenous fistula or central venous catheter (CVC) - and as this access is frequently used, they are particularly susceptible to bloodstream infections and local infections at the vascular access site. Unfortunately, there is little reliable data on appropriate infection prevention for this group of people. A group of researchers at the Charité in Berlin, Germany, investigated the effects of a multimodal prevention strategy on dialysis-associated infection events (DAIE) over a 24-month period [2]. The prevention strategy consisted of infection surveillance with regular feedback, open observation of hand hygiene (HH) with structured feedback on HH compliance, intensified training in aseptic procedures and a patient flyer on dialysis risk and access management.
The large-scale study involved 43 outpatient dialysis centres with a total of 11,251 patients who received more than 1.4 million dialysis treatments between October 2019 and September 2021. All centres underwent both a control period and an intervention period during the study. The results showed that DAIE occurred at a rate of 0.71 per 1,000 dialysis treatments in the control period, compared to 0.31 per 1,000 dialysis treatments in the intervention period. The preventive effect of the intervention bundle was greatest in patients with CVC, who made up about a quarter of the group in this study. In these patients, the risk of DAIE was reduced by almost 60%.
In addition to the incidence of DAIE, the study also analysed the effect of the intervention bundle on HH adherence. It was found that HH observation combined with feedback and increased training increased overall HH compliance from 58% to 65%. In addition, DAIE incidence rates over time (before and after the intervention) were compared with HH compliance rates. The result: as HH compliance increased, the rate of DAIE decreased. Overall, the results indicate that implementation of the multimodal prevention strategy can improve HH compliance and significantly reduce the risk of DAIE - especially in outpatients with CVC. A Canadian study also showed that infection control programmes can have a positive impact on healthcare costs [3]. In addition to preventing bloodstream infections, multimodal prevention strategies should also have a positive impact on the prevention of other nosocomial infections.
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