title: Reduction in Staphylococcus aureus bacteraemia rates in patients receiving haemodialysis following alteration of skin antisepsis procedures.
abstract: This study examined all cases of Staphylococcus aureus bacteraemia (SAB) in the haemodialysis cohort at the Royal Darwin Hospital, Australia over a seven-year period. Midway through this period, antisepsis for arteriovenous fistulae (AVF) and central venous catheters (CVC) changed from 0.5% chlorhexidine solution to 2% chlorhexidine solution. Rates of SAB episodes were calculated using registry data. Trends in SAB over time were analysed using an interrupted regression analysis. Following the change to 2% chlorhexidine, average SAB rates decreased by 68%, and it is estimated that 0.111 cases of SAB/patient-year were prevented. CVC-related SAB rates remained low throughout. These results support the use of 2% chlorhexidine in skin antisepsis for patients with AVF.
authors.affiliation: Department of Nephrology, Royal Darwin Hospital, Darwin, Australia; Division of Medical Sciences, University of Oxford, Oxford, UK.
authors.forename: B J
authors.initials: BJ
authors.lastname: Stewart
authors.affiliation: Infection Prevention and Management Unit, Royal Darwin Hospital, Darwin, Australia; Infection Control Unit, Queen Elizabeth II Hospital, Brisbane, Australia.
authors.forename: T
authors.initials: T
authors.lastname: Gardiner
authors.affiliation: Department of Nephrology, Royal Darwin Hospital, Darwin, Australia; Department of Nephrology, Royal Perth Hospital, Perth, Australia.
authors.forename: G J
authors.initials: GJ
authors.lastname: Perry
authors.affiliation: Menzies School of Health Research, Darwin, Australia. Electronic address: steven.tong@menzies.edu.au.
authors.forename: S Y C
authors.initials: SY
authors.lastname: Tong
mesh_terms: D000891:Anti-Infective Agents, Local / Q000008:administration & dosage; D000985:Antisepsis / Q000379:methods*; D001315:Australia / Q000453:epidemiology; D016470:Bacteremia / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*; D055499:Catheter-Related Infections / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*; D002710:Chlorhexidine / Q000008:administration & dosage; D006761:Hospitals; D006801:Humans; D006435:Renal Dialysis / Q000009:adverse effects*; D012189:Retrospective Studies; D012867:Skin / Q000382:microbiology*; D013203:Staphylococcal Infections / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*; D013211:Staphylococcus aureus / Q000302:isolation & purification*
chemical_list: D000891:Anti-Infective Agents, Local; D002710:Chlorhexidine
keywords: ANZDATA; Arteriovenous fistula; Central venous catheter; Chlorhexidine; Haemodialysis; Staphylococcus aureus