title: Non-compliance to the continuous ambulatory peritoneal dialysis procedure increases the risk of peritonitis.
abstract: BACKGROUND
  Peritonitis in patients on continuous ambulatory peritoneal dialysis (CAPD) is the leading cause of technique failure. Information on the impact of non-compliance in performing CAPD exchange on peritonitis is limited. We aimed to find the prevalence of non-compliance to the CAPD procedure and its influence on the incidence of peritonitis.
  
  
  METHODS
  This observational study included 30 adult patients undergoing CAPD. The CAPD exchange procedure was observed at home and assessed as per the structured checklist and categorized into poor, average and good compliance. The compliance was correlated with the episodes of peritonitis in previous 1 year.
  
  
  RESULTS
  The patients' mean age was 52 ± 13 years and the mean duration of CAPD was 2.1 ± 0.9 years. Only 16.5% of patients were good performers, while 67% were average performers, and 16.5% were poor performers. The technique skill was similar across all the steps of the procedure. The most common improperly performed steps were: not putting on a face mask in 68%, not flushing the tubing system in 60%, and not washing hands in 24%. Poor adherence to procedure was independent of age, gender, education and duration of dialysis. Ten episodes of peritonitis occurred in 5 patients over 1-year period. Peritonitis occurred in 60% of poor performers, whereas fully compliant patients had no peritonitis. Also 40% of the poorly compliant patients had multiple episodes of peritonitis.
  
  
  CONCLUSIONS
  Poor compliance in performing the CAPD procedure is a modifiable risk factor for peritonitis. Adherence to recommended aseptic technique is the cornerstone of peritonitis prevention.
authors.affiliation: College of Nursing, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Shashi
authors.initials: S
authors.lastname: Mawar
authors.forename: Sanjay
authors.initials: S
authors.lastname: Gupta
authors.forename: Sandeep
authors.initials: S
authors.lastname: Mahajan
mesh_terms: D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007194:India / Q000453:epidemiology; D007676:Kidney Failure, Chronic / Q000150:complications / Q000453:epidemiology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D010531:Peritoneal Dialysis, Continuous Ambulatory / Q000523:psychology*; D010538:Peritonitis / Q000453:epidemiology* / Q000209:etiology; D015995:Prevalence; D012307:Risk Factors; D017211:Treatment Failure
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