RESEARCH ARTICLE


CLABSI in Hemodialysis– New Face to an Old Foe; A Look at Current Trends and a Review of Literature



Nisha Jose1, *, Manikantan S.2, #, Kevin John2, Ram Prasad2, M. Jayakumar2
1 Christian Medial College and hospital, Vellore, India
2 Sri Ramachandra Institute of Higher Education and Research, Tamil Nadu, India


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Creative Commons License
© 2022 Jose et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: https://creativecommons.org/licenses/by/4.0/legalcode. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Christian Medial College and hospital, Vellore, India and Sri Ramachandra Institute of Higher Education and Research, Tamil Nadu, India; Tel: 09655594316; E-mails josenisha2000@gmail.com and dr_manishekar@yahoo.com
# This author contributed equally


Abstract

Background:

Bloodstream infections are a potentially devastating complication of hemodialysis. This study aimed to elucidate the rates of CLABSI (Central Line Associated Blood Stream Infections)in a south Indian dialysis cohort and determine the catheter care and hygiene practices in the dialysis unit which might contribute to CLABSI

Methods:

A prospective observational study involving in-center dialysis patients with temporary access was conducted from June 2019 to December 2019. The catheter insertion and line handling techniques were monitored using a proforma adapted from the CDC (Center for Disease Control) guidelines. Adherence to infection control practices, rates of CLABSI identified using CDC surveillance definitions, and organisms identified were reported.

Results and Discussion:

The median rate of CLABSI in this dialysis unit was 1.68 per 1000 catheter days. Gram-positive organisms were the majority – 69.2% and 72.27% were drug-resistant pathogens. The adherence to infection control practices in hand sterility, use of barriers, and sterile insertion technique were 100% with respect to existing CDC guidelines. The use of sterile semi-transparent dressings, however, was 98.2%. 65% of all patients had soiled dressings on arrival to the hospital. Line handling protocols were followed in accordance with CDC guidelines in 97.1% of cases

Conclusion:

CLABSI rates in this institute are in keeping with those around the world. There is a predominance of gram-positive organisms causing CLABSI. Drug-resistant organisms represent an alarming 72.27%of all infections. Soiled dressing and home care of the dialysis catheters represent a neglected aspect of catheter care and should be addressed.

Keywords: CLABSI, Hemodialysis, Temporary catheter, Line infections, Infection control practices, Nephrology.