Mr JAYSON CATIWA1, Ms SARAH COGGAN1, Dr ALAN CASS2, Associate Professor NICHOLAS GRAY3, Dr STEPHEN JAN1, DR STEPHEN MCDONALD4, DR KEVAN POLKINGHORNE5, DR GIRISH TALAULIKAR6, Professor MARTIN GALLAGHER1, Dr SRADHA KOTWAL1
1The George Institute for Global Health, Sydney, Australia, 2Charles Darwin University, Darwin, Australia, 3Sunshine Coast University Hospital, Birtinya, Australia, 4South Australia Health and Medical Research Institute, Adelaide, Australia, 5Monash University, , Australia, 6ACT Health, Canberra, Australia
Aim
To compare the concordance between reporting of haemodialysis catheter-related bloodstream infectious (HD CRBSI) events by participating kidney services and the corresponding central adjudication outcomes in the REDUcing the burden of Catheter ComplicaTIONs-a National approach (REDUCCTION) trial.
Background
HD CRBSI are a significant source of morbidity and mortality among haemodialysis patients. Varying definitions and interpretations of HD CRBSI make meaningful comparisons difficult. Attempts at systematically improving infection rates require a consistent approach in measuring HD CRBSI and understanding the feasibility and accuracy of this reporting is crucial.
Methods
HD CRBSI events reported between December 2016 to March 2020 by participating Australian and New Zealand kidney services were compared against the central adjudicators reported outcomes using the definition and adjudication processes of the REDUCCTION trial. Agreement between centre and adjudicators was estimated using Cohen’s kappa statistic (κ) clustered by sites and implementation tranches.
Results
779 HD catheter-related infectious events were reported by 42 sites across 7,258 patients, 12,630 catheters and 1.3 million catheter days. Of the 779, 385 events were Confirmed HD CRBSI; 87% were concordant with the final adjudicated outcome. The crude agreement for Possible HD CRBSI (n=182) and Other catheter-related infectious events (n=212) was above 65%. Moderate to almost perfect agreement were evident from baseline to the last tranche of intervention implementation; overall concordance was κ=0.71 (95%CI 0.66-0.76).
Conclusions
Our study revealed a substantial level of concordance in the HD CRBSI reporting between the participating kidney services and the REDUCCTION trial adjudicators, demonstrating reliability in Australian and New Zealand site-based reporting of HD CRBSI rates. Ascertaining HD CRBSI using a standardised definition allowed for comparable adjudication of outcomes with reliable benchmarking between kidney services.
Biography:
Jayson is a Renal Access Clinical Nurse Consultant at a large tertiary teaching hospital in NSW Health, Sydney. He is doing his PhD at The George Institute for Global Health. Jayson is a haemodialysis clinician with over 10 years of both local and international experience looking after paediatric and adult dialysis patients. He has completed his Masters degree with Renal nursing specialisation and served as a lecturer/facilitator for nursing students at various institutions. He has a strong passion for vein preservation, vascular access coordination and improving dialysis access outcomes of end-stage kidney disease patients in acute and satellite haemodialysis settings.