title: Predictors of hemodialysis central venous catheter exit-site infections.
abstract: Central venous catheter (CVC) exit-site infections contribute to bacteremia and patient morbidity and mortality among patients on hemodialysis. This structured observational study examined predictors of positive CVC exit-site infections. Hemodialysis nurses documented the physical appearance of the CVC exit site for sites they believed to be infected and required a swab culture. Additional information that pertained to the catheter, exit-site care and demographic data were also collected. No patient characteristics were associated with an exit-site infection. However, the type of dressing (p=0.007) and cleansing solution (p=0.007) used were positively associated with an exit-site infection. Negative exit-site culture reports were more likely to have dressings changed weekly (p=0. 03). The size of peri-wound erythema (p=0.008) was also associated with a higher incidence of exit-site infections. Patients with dry crust present at the exit site were more likely to have negative culture results (p=0.03). A large number of negative swab culture results (71%) were obtained suggesting that further nursing education is needed. The results of this study contribute to our understanding of the physical characteristics of an infected CVC exit site. Given the morbidity and mortality associated with CVC infections, more nursing research is needed in this area.
authors.affiliation: Adam Linton Hemodialysis Unit, London Health Sciences Centre, London, Ontario, Canada. lori.harwood@lhsc.on.ca
authors.forename: Lori
authors.initials: L
authors.lastname: Harwood
authors.forename: Barbara
authors.initials: B
authors.lastname: Wilson
authors.forename: Bonita
authors.initials: B
authors.lastname: Thompson
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Brown
authors.forename: Danae
authors.initials: D
authors.lastname: Young
mesh_terms: D000328:Adult; D000368:Aged; D016470:Bacteremia / Q000209:etiology; D001458:Bandages / Q000009:adverse effects; D002170:Canada / Q000453:epidemiology; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D002408:Catheters, Indwelling / Q000009:adverse effects*; D002985:Clinical Protocols; D003428:Cross Infection / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D005260:Female; D006436:Hemodialysis Units, Hospital; D006801:Humans; D017053:Infection Control / Q000379:methods; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D009730:Nursing Assessment / Q000379:methods; D015403:Nursing Evaluation Research; D011237:Predictive Value of Tests; D006435:Renal Dialysis / Q000295:instrumentation*; D012307:Risk Factors; D017592:Skin Care / Q000009:adverse effects / Q000379:methods / Q000451:nursing