Nosocomial infections in dialysis access.

Schweiger, Alexander; Trevino, Sergio; Marschall, Jonas (2015). Nosocomial infections in dialysis access. Contributions to nephrology, 184, pp. 205-221. Karger 10.1159/000366120

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Nosocomial infections in patients requiring renal replacement therapy have a high impact on morbidity and mortality. The most dangerous complication is bloodstream infection (BSI) associated with the vascular access, with a low BSI risk in arteriovenous fistulas or grafts and a comparatively high risk in central venous catheters. The single most important measure for preventing BSI is therefore the reduction of catheter use by means of early fistula formation. As this is not always feasible, prevention should focus on educational efforts, hand hygiene, surveillance of dialysis-associated events, and specific measures at and after the insertion of catheters. Core measures at the time of insertion include choosing the optimal site of insertion, the use of maximum sterile barrier precautions, adequate skin antisepsis, and the choice of catheter type; after insertion, access care needs to ensure hub disinfection and regular dressing changes. The application of antimicrobial locks is reserved for special situations. Evidence suggests that bundling a selection of the aforementioned measures can significantly reduce infection rates. The diagnosis of central line-associated BSI (CLABSI) is based on clinical signs and microbiological findings in blood cultures ideally drawn both peripherally and from the catheter. The prompt installation of empiric antibiotic treatment covering the most commonly encountered organisms is key regarding CLABSI treatment. Catheter removal is recommended in complicated cases or if cultures yield Staphylococcus aureus, enterococci, Pseudomonas or fungi. In other cases, guide wire exchange or catheter salvage strategies with antibiotic lock solutions may be acceptable alternatives.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Haematology, Oncology, Infectious Diseases, Laboratory Medicine and Hospital Pharmacy (DOLS) > Clinic of Infectiology

UniBE Contributor:

Schweiger, Alexander and Marschall, Jonas

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0302-5144

Publisher:

Karger

Language:

English

Submitter:

Annelies Luginbühl

Date Deposited:

18 Feb 2015 09:37

Last Modified:

19 Oct 2015 11:10

Publisher DOI:

10.1159/000366120

PubMed ID:

25676304

BORIS DOI:

10.7892/boris.63308

URI:

https://boris.unibe.ch/id/eprint/63308

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