title: A contemporary approach to the prevention of peritoneal dialysis-related peritonitis in children: the role of improvement science.
abstract: Peritonitis is a leading cause of hospitalizations, morbidity, and modality change in pediatric chronic peritoneal dialysis (CPD) patients. Despite guidelines published by the International Society for Peritoneal Dialysis aimed at reducing the risk of peritonitis, registry data have revealed significant variability in peritonitis rates among centers caring for children on CPD, which suggests variability in practice. Improvement science methods have been used to reduce a variety of healthcare-associated infections and are also being applied successfully to decrease rates of peritonitis in children. A successful quality improvement program with the goal of decreasing peritonitis will not only include primary drivers directly linked to the outcome of peritonitis, but will also direct attention to secondary drivers that are important for the achievement of primary drivers, such as health literacy and patient and family engagement strategies. In this review, we describe a comprehensive improvement science model for the reduction of peritonitis in pediatric patients on CPD.
authors.affiliation: Pediatric Nephrology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA. acredpath@pediatrics.wisc.edu.
authors.forename: Allison
authors.initials: A
authors.lastname: Redpath Mahon
authors.affiliation: Pediatric Nephrology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Alicia M
authors.initials: AM
authors.lastname: Neu
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis / Q000379:methods*; D002408:Catheters, Indwelling / Q000009:adverse effects* / Q000382:microbiology; D002648:Child; D003428:Cross Infection / Q000517:prevention & control*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D010353:Patient Education as Topic; D010530:Peritoneal Dialysis / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods / Q000592:standards; D010538:Peritonitis / Q000191:economics / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D017410:Practice Guidelines as Topic; D058996:Quality Improvement; D012042:Registries / Q000706:statistics & numerical data; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000191:economics / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D013211:Staphylococcus aureus / Q000302:isolation & purification
chemical_list: D000900:Anti-Bacterial Agents
keywords: Care bundles; Exit site infection; Health literacy; Home visit; Patient engagement; Peritonitis; Quality improvement