Exit-site care in Austrian peritoneal dialysis centers -- a nationwide survey.
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).
Kopriva-Altfahrt
Gertrude
G
Division of Nephrology and Dialysis, Department of Medicine VI, Wilhelminenspital, Vienna.
König
Paul
P
Mündle
Michael
M
Prischl
Friedrich
F
Roob
Johannes M
JM
Wiesholzer
Martin
M
Vychytil
Andreas
A
Arneitz
Kalus
K
Karner
Andrea
A
Artes
Rene
R
Wolf
Erich
E
Auinger
Martin
M
Pawlak
Andrzej
A
Fraberger
Johannes
J
Hofbauer
Sabine
S
Galvan
Georg
G
Salmhofer
Hermann
H
Pichler
Birgit
B
Wazel
Melanie
M
Gruber
Manfred
M
Thonhofer
Anni
A
Hager
Alfred
A
Malajner
Sabine
S
Heiss
Susanne
S
Braunsteiner
Thomas
T
Zweiffler
Monika
M
König
Paul
P
Rudnicki
Michael
M
Kogler
Richard
R
Kohlhauser
Dietmar
D
Wiesinger
Tatjana
T
Kopriva-Altfahrt
Gertrude
G
Moser
Elizabeth
E
Kotanko
Peter
P
Loibner
Herbert
H
Nitz
Helga
H
Miska
Hans Joachim
HJ
Wenzel
René
R
Wölfer
Monika
M
Mündle
Michael
M
Breuss
Heimo
H
Hölzl
Bertram
B
Prischi
Friedrich
F
Schmekal
Bernhard
B
Riener
Eva-Maria
EM
Roob
Johannes M
JM
Wonisch
Waltraud
W
Vikydal
Rudolf
R
Vychytil
Andreas
A
Frank
Barbara
B
Wieser
Clemens
C
Wiesholzer
Martin
M
Pokorny
Karin
K
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
D000900:Anti-Bacterial Agents