title: A prospective study of infections in hemodialysis patients: patient hygiene and other risk factors for infection.
abstract: We performed a prospective randomized study on 71 patients on chronic outpatient hemodialysis to determine whether a sterile technique was better than a clean technique for preparation of the skin over the vascular access site prior to cannulation. In addition, we wanted to determine overall and site-specific infection rates, microbial etiologies of infection, and risk factors for infection. The overall infection rate was 4.7 infections per 100 dialysis months; the vascular access-site infection rate was 1.3 infections per 100 dialysis months; and the rate for bacteremia was 0.7 cases per 100 dialysis months. Staphylococcus aureus was the most common pathogen, but infections were equally divided between gram-positive cocci and gram-negative bacilli. Advanced age (P = 0.02), a low Karnofsky activity score (P = 0.05), poor hygiene (P = 0.0004) and number of hospitalizations (P = 0.0002) were risk factors for infections in general while only poor hygiene (P = 0.002) was a risk factor for vascular access-site infection. Sterile preparation of the skin over the vascular access site was no more effective at preventing infection than was clean technique (P = 0.80). Maintenance of good personal hygiene may be one of the most important measures for prevention of infections in hemodialysis patients.
authors.affiliation: Department of Medicine, Medical College of Virginia, Virginia Commonwealth University, Richmond 23298-0019.
authors.forename: L G
authors.initials: LG
authors.lastname: Kaplowitz
authors.forename: J A
authors.initials: JA
authors.lastname: Comstock
authors.forename: D M
authors.initials: DM
authors.lastname: Landwehr
authors.forename: H P
authors.initials: HP
authors.lastname: Dalton
authors.forename: C G
authors.initials: CG
authors.lastname: Mayhall
mesh_terms: D000328:Adult; D000368:Aged; D001424:Bacterial Infections / Q000453:epidemiology; D004203:Disinfection / Q000379:methods*; D005260:Female; D006801:Humans; D006920:Hygiene; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011897:Random Allocation; D006435:Renal Dialysis; D012307:Risk Factors; D012867:Skin / Q000382:microbiology; D013203:Staphylococcal Infections / Q000453:epidemiology*; D013242:Sterilization / Q000379:methods*