Hemodialysis Infection Prevention Protocols Ontario-Shower Technique (HIPPO-ST): A Pilot Randomized Trial

Overview

Journal Kidney Int Rep

Publisher Elsevier

Specialty Nephrology

Date 2017 Nov 17

PMID 29142959

Authors

S Daisy Kosa

Amiram Gafni

Andrew A House

JulieAnn Lawrence

Louise Moist

Bharat Nathoo

Paul Tam

Alicia Sarabia

Lehana Thabane

George Wu

Charmaine E Lok

Affiliations

Soon will be listed here.

Abstract

Introduction: We developed the Hemodialysis Infection Prevention Protocols Ontario-Shower Technique (HIPPO-ST) to permit hemodialysis (HD) patients with central venous catheters (catheters) to shower without additional infection risk. Our primary objective was to determine the feasibility of conducting a parallel randomized controlled trial (RCT) to evaluate the impact of HIPPO-ST on catheter-related bacteremia (CRB) in adult HD patients.

Methods: Adult HD patients using catheters were recruited from 11 HD units. Patients were randomized to receive HIPPO-ST or standard care and were followed up for 6 months. Only CRB-outcome assessors were blinded. For the study to be considered feasible, 4 of 5 feasibility outcomes, each with its own statistical threshold for success, must have been achieved.

Results: A total of 68 patients were randomized (33 HIPPO-ST and 35 control) and were followed up to 6 months. Of 5 measures of feasibility, 4 were achieved: (1) accurate CRB rate documented (threshold: κ level >0.80); (2) 97.8% (279/285) of satellite HD patients with catheters were screened (threshold: >95%); (3) 88% (23/26) in the HIPPO-ST arm were successfully educated by 6 months (threshold: >80%); and (4) 0% (0/29) patients in the control arm were "contaminated," that is, using HIPPO-ST (threshold: <5%). However, only 44.2% (72/163) of eligible patients consented to participate (threshold: >80%). The rate of CRB was similarly low in HIPPO-ST and control groups (0.68 vs. 0.88/1000 catheter days).

Discussion: This HIPPO-ST pilot study demonstrated the feasibility of the larger HIPPO-ST study, especially given the high levels of education success with the HIPPO-ST arm and the low levels of contamination in the control arm.

References

Tonnessen B, Money S . Embracing the fistula first national vascular access improvement initiative. J Vasc Surg. 2005; 42(3):585-6. DOI: 10.1016/j.jvs.2005.05.030. View

Lee T, Lok C, Vazquez M, Moist L, Maya I, Mokrzycki M . Minimizing hemodialysis catheter dysfunction: an ounce of prevention. Int J Nephrol. 2012; 2012:170857. PMC: 3299246. DOI: 10.1155/2012/170857. View

Nissenson A, Dylan M, Griffiths R, Yu H, Dean B, Danese M . Clinical and economic outcomes of Staphylococcus aureus septicemia in ESRD patients receiving hemodialysis. Am J Kidney Dis. 2005; 46(2):301-8. DOI: 10.1053/j.ajkd.2005.04.019. View

Evans E, Hain D, Kear T, Dork L, Schrauf C . Hemodialysis catheter outcomes pilot study: no dressing coverage with prescribed showering. Nephrol Nurs J. 2014; 41(1):53-64. View

Manian F . IDSA guidelines for the diagnosis and management of intravascular catheter-related bloodstream infection. Clin Infect Dis. 2009; 49(11):1770-1. DOI: 10.1086/648113. View

Chaudhry M, Bhola C, Joarder M, Zimmerman D, Quinan P, Mendelssohn D . Seeing eye to eye: the key to reducing catheter use. J Vasc Access. 2011; 12(2):120-6. DOI: 10.5301/jva.2011.6390. View

Lopes A, Bragg-Gresham J, Goodkin D, Fukuhara S, Mapes D, Young E . Factors associated with health-related quality of life among hemodialysis patients in the DOPPS. Qual Life Res. 2007; 16(4):545-57. DOI: 10.1007/s11136-006-9143-7. View

Mokrzycki M, Zhang M, Cohen H, Golestaneh L, Laut J, Rosenberg S . Tunnelled haemodialysis catheter bacteraemia: risk factors for bacteraemia recurrence, infectious complications and mortality. Nephrol Dial Transplant. 2006; 21(4):1024-31. DOI: 10.1093/ndt/gfi104. View

Engemann J, Friedman J, Reed S, Griffiths R, Szczech L, Kaye K . Clinical outcomes and costs due to Staphylococcus aureus bacteremia among patients receiving long-term hemodialysis. Infect Control Hosp Epidemiol. 2005; 26(6):534-9. DOI: 10.1086/502580. View

10.

OGrady N, Alexander M, Dellinger E, Gerberding J, Heard S, Maki D . Guidelines for the prevention of intravascular catheter-related infections. Centers for Disease Control and Prevention. MMWR Recomm Rep. 2002; 51(RR-10):1-29. View

11.

Lynn M . Determination and quantification of content validity. Nurs Res. 1986; 35(6):382-5. View

12.

Schulz K, Altman D, Moher D . CONSORT 2010 statement: updated guidelines for reporting parallel group randomized trials. Ann Intern Med. 2010; 152(11):726-32. DOI: 10.7326/0003-4819-152-11-201006010-00232. View

13.

Lok C, Thomas A, Vercaigne L . A patient-focused approach to thrombolytic use in the management of catheter malfunction. Semin Dial. 2006; 19(5):381-90. DOI: 10.1111/j.1525-139X.2006.00168.x. View

14.

Battistella M, Bhola C, Lok C . Long-term follow-up of the Hemodialysis Infection Prevention with Polysporin Ointment (HIPPO) Study: a quality improvement report. Am J Kidney Dis. 2011; 57(3):432-41. DOI: 10.1053/j.ajkd.2010.10.009. View

15.

Lawrence J, Seiler S, Wilson B, Harwood L . Shower and no-dressing technique for tunneled central venous hemodialysis catheters: a quality improvement initiative. Nephrol Nurs J. 2014; 41(1):67-72. View

16.

Quinn R, Lamping D, Lok C, Meyer R, Hiller J, Lee J . The Vascular Access Questionnaire: assessing patient-reported views of vascular access. J Vasc Access. 2008; 9(2):122-8. View

17.

Jindal K, Chan C, Deziel C, Hirsch D, Soroka S, Tonelli M . Hemodialysis clinical practice guidelines for the Canadian Society of Nephrology. J Am Soc Nephrol. 2006; 17(3 Suppl 1):S1-27. DOI: 10.1681/ASN.2005121372. View

18.

Tanriover B, Carlton D, Saddekni S, Hamrick K, Oser R, Westfall A . Bacteremia associated with tunneled dialysis catheters: comparison of two treatment strategies. Kidney Int. 2000; 57(5):2151-5. DOI: 10.1046/j.1523-1755.2000.00067.x. View

19.

Lok C, Bhola C, Croxford R, Richardson R . Reducing vascular access morbidity: a comparative trial of two vascular access monitoring strategies. Nephrol Dial Transplant. 2003; 18(6):1174-80. DOI: 10.1093/ndt/gfg122. View

20.

Ishani A, Collins A, Herzog C, Foley R . Septicemia, access and cardiovascular disease in dialysis patients: the USRDS Wave 2 study. Kidney Int. 2005; 68(1):311-8. DOI: 10.1111/j.1523-1755.2005.00414.x. View