title: Exit-site care in Austrian peritoneal dialysis centers -- a nationwide survey.
abstract: BACKGROUND
  Catheter-associated infections markedly contribute to treatment failure in peritoneal dialysis (PD) patients. There is much controversy surrounding prophylactic strategies to prevent these infections.
  
  
  METHODS
  In this nationwide multicenter study we analyzed strategies to prevent catheter-associated infections as performed in Austrian PD centers in 2006. A questionnaire was sent to all 23 PD centers in Austria.
  
  
  RESULTS
  Ten different catheter models were used in the 332 patients being treated in the 23 Austrian PD centers. Systemic antibiotics prior to catheter placement were given by 17 of the 23 PD centers (glycopeptides, n = 7; cephalosporins, n = 10). Nasal swabs were taken preoperatively by 17 PD centers; nasal Staphylococcus aureus carriers were treated prophylactically with mupirocin cream in 15 of these centers. Dressing change was routinely performed in 318 of 332 chronic PD patients (nonocclusive film dressing, n = 58; gauze dressing, n = 260). Disinfectants for chronic exit-site care included povidone iodine (n = 155), sodium hypochlorite (n = 31), povidone iodine + sodium hypochlorite together (n = 102), and octenidine dihydrochloride/phenoxyethanol (n = 17). Water + non-disinfectant soap or 0.9% sodium chloride was administered as a cleansing agent to the exit site by 27 patients. Routine S. aureus screening (nasal and/or exit-site swabs) in chronic PD patients was performed in 12 PD centers; carriers were treated with mupirocin cream in 11 of these centers. Dialysis staff members were screened for S. aureus in 8 PD centers and spouses were screened for S. aureus in 5 PD centers. The overall exit-site infection rate was 1 episode/43.9 patient-months, tunnel infection rate was 1 episode/88.9 patient-months, and peritonitis rate was 1 episode/51.0 patient-months. Patients of centers that have installed a prophylaxis protocol for treating S. aureus carriers had lower mean infection rates compared with those not using such a protocol.
  
  
  CONCLUSIONS
  Various individual prophylactic strategies are used to prevent catheter-associated infections in Austrian PD centers. Infection rates are within the range reported in the literature. There is still scope for improvement in some centers (e.g., by establishing a prophylaxis protocol).
authors.affiliation: Division of Nephrology and Dialysis, Department of Medicine VI, Wilhelminenspital, Vienna.
authors.forename: Gertrude
authors.initials: G
authors.lastname: Kopriva-Altfahrt
authors.forename: Paul
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authors.lastname: König
authors.forename: Michael
authors.initials: M
authors.lastname: Mündle
authors.forename: Friedrich
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authors.lastname: Prischl
authors.forename: Johannes M
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authors.lastname: Roob
authors.forename: Martin
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authors.lastname: Wiesholzer
authors.forename: Andreas
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authors.lastname: Vychytil
authors.forename: Kalus
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authors.forename: Andrea
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authors.forename: Rene
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authors.forename: Andrzej
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authors.lastname: Pawlak
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authors.lastname: Fraberger
authors.forename: Sabine
authors.initials: S
authors.lastname: Hofbauer
authors.forename: Georg
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authors.lastname: Galvan
authors.forename: Hermann
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authors.lastname: Salmhofer
authors.forename: Birgit
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authors.lastname: Pichler
authors.forename: Melanie
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authors.lastname: Wazel
authors.forename: Manfred
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authors.forename: Anni
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authors.forename: Alfred
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authors.lastname: Malajner
authors.forename: Susanne
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authors.lastname: Braunsteiner
authors.forename: Monika
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authors.lastname: König
authors.forename: Michael
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authors.lastname: Rudnicki
authors.forename: Richard
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authors.lastname: Kogler
authors.forename: Dietmar
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authors.lastname: Kohlhauser
authors.forename: Tatjana
authors.initials: T
authors.lastname: Wiesinger
authors.forename: Gertrude
authors.initials: G
authors.lastname: Kopriva-Altfahrt
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Moser
authors.forename: Peter
authors.initials: P
authors.lastname: Kotanko
authors.forename: Herbert
authors.initials: H
authors.lastname: Loibner
authors.forename: Helga
authors.initials: H
authors.lastname: Nitz
authors.forename: Hans Joachim
authors.initials: HJ
authors.lastname: Miska
authors.forename: René
authors.initials: R
authors.lastname: Wenzel
authors.forename: Monika
authors.initials: M
authors.lastname: Wölfer
authors.forename: Michael
authors.initials: M
authors.lastname: Mündle
authors.forename: Heimo
authors.initials: H
authors.lastname: Breuss
authors.forename: Bertram
authors.initials: B
authors.lastname: Hölzl
authors.forename: Friedrich
authors.initials: F
authors.lastname: Prischi
authors.forename: Bernhard
authors.initials: B
authors.lastname: Schmekal
authors.forename: Eva-Maria
authors.initials: EM
authors.lastname: Riener
authors.forename: Johannes M
authors.initials: JM
authors.lastname: Roob
authors.forename: Waltraud
authors.initials: W
authors.lastname: Wonisch
authors.forename: Rudolf
authors.initials: R
authors.lastname: Vikydal
authors.forename: Andreas
authors.initials: A
authors.lastname: Vychytil
authors.forename: Barbara
authors.initials: B
authors.lastname: Frank
authors.forename: Clemens
authors.initials: C
authors.lastname: Wieser
authors.forename: Martin
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authors.lastname: Wiesholzer
authors.forename: Karin
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authors.lastname: Pokorny
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001317:Austria; D055499:Catheter-Related Infections / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D002408:Catheters, Indwelling / Q000009:adverse effects*; D020878:Device Removal; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D016908:Gram-Positive Bacterial Infections / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D010530:Peritoneal Dialysis / Q000009:adverse effects* / Q000295:instrumentation*; D010818:Practice Patterns, Physicians'; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents