Dr Benjamin Lazarus1,2,3, Dr Elisa Bongetti1,2, Dr Jonathan Ling1,2, Prof Martin Gallagher3,4, Dr Sradha Kotwal3,5, Prof Kevan Polkinghorne1,2
1Monash University, Melbourne, Australia, 2Monash Health, Clayton, Australia, 3The George Institute for Global Health, Newtown, Australia, 4South Western Sydney Campus, UNSW, Sydney, Australia, 5Prince of Wales Hospital, UNSW, Sydney, Australia
Aim: To determine whether the implementation of a multifaceted intervention in ambulatory haemodialysis services can prevent haemodialysis catheter-related bloodstream infections (HDCRBSI) compared to usual care.
Background: Central venous catheters (CVCs) are widely used for haemodialysis access, but frequently lead to burdensome and costly bloodstream infections. It is unclear whether HDCRBSI or access-related BSI (ARBSI) can be prevented through multifaceted interventions.
Methods: We searched PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials from inception to 23rd April 2022 using a sensitive keyword search strategy (PROSPERO CRD42021252290). All randomized trials, interrupted time series (ITS), and before-after studies that examined the effect of multifaceted interventions on incidence of HDCRBSI or ARBSI were included. Two authors independently extracted data and assessed risk of bias and quality of evidence using validated tools. Random effects meta-analysis of the intervention effect was planned for HDCRBSI and ARBSI.
Results: We evaluated 8824 non-duplicate citations, 117 full texts and included 20 unique studies, of which 15 assessed HDCRBSI and 5 assessed ARBSI only. Among the eight HDCRBSI studies eligible for meta-analysis, two cluster randomized trials had conflicting results, two ITS studies reported an effective intervention but with conflicting patterns of effect, and all four before-after studies reported a favourable effect with serious risk of bias. None of the ARBSI studies were eligible for meta-analysis. The overall GRADE of evidence for an intervention effect on HDCRBSI and ARBSI was very low.
Conclusion: Most studies report a favourable effect of multifaceted interventions on HDCRBSI, but the quality of evidence is very low and studies with lower risk of bias showed less or no effect. Further high-quality studies are warranted.
Biography:
Ben is an early career nephrologist at Monash Health and a full time PhD candidate at Monash University and The George Institute of Global Health. His thesis examines the risks of using central venous catheters for haemodialysis in Australia, and the opportunities we all have to make these devices safer for patients.