None listed
Conditions
Brief summary
The primary purpose of the study is to see if assisting 8 renal units to actively put certain clinical practice guideline recommendations into practice will result in fewer infections and a longer time to first infection in their peritoneal dialysis patients. The study hypothesis is that assisting nephrologists and renal nurses to follow infection prevention guidelines in their daily practice will lead to better patient outcomes in terms of less PD-related infections, better quality of life, less need to remove Tenckhoff catheters and less technique failure (and transfer to haemodialysis or withdrawal from dialysis altogether).
Interventions
Intervention: Active implementation of 3 evidence-based guideline recommendations. *Guideline recommendation #1: Intravenous antibiotic prophylaxis prior to peritoneal dialysis catheter insertion should be used to reduce the risk of early peritonitis (Level I evidence) (either Vancomycin, Cephalosporin or Gentamicin can be used)
How it will be implemented: A clinical pathway will be developed with surgical team input to include IV antibiotic administration pre-operatively by a designated individ
Intervention: Active implementation of 3 evidence-based guideline recommendations. *Guideline recommendation #1: Intravenous antibiotic prophylaxis prior to peritoneal dialysis catheter insertion should be used to reduce the risk of early peritonitis (Level I evidence) (either Vancomycin, Cephalosporin or Gentamicin can be used) How it will be implemented: A clinical pathway will be developed with surgical team input to include IV antibiotic administration pre-operatively by a designated individual. A 1-page checklist will also be developed. *Guideline recommendation #2: Prophylactic therapy using mupirocin ointment, especially for Staphylococcus aureus carriage (intranasally or at exit site) is recommended to decrease the risk of Staphylococcus aureus catheter exit site/tunnel infections and peritonitis (Level I evidence). How it will be implemented: Units can choose 1 of 2 options: 1) Unit protocol to include nasal swabbing of each PD patient every 6 months by a nurse, with treatment (nasal mupirocin) prescribed on the return of a positive swab for S. aureus or MRSA. Patient and staff education to explain that this should occur. 2) Unit protocol to include daily application of mupirocin to catheter exit site by patient/carer or nurse. Patient, GP and staff education to explain that this is the agreed procedure. A 1-page checklist will also be developed for both options. *Guideline recommendation #3: The use of oral antifungal prophylaxis should be considered at the time of antibiotic administration to peritoneal dialysis patients to reduce the occurrence of fungal peritonitis (Level II evidence). How it will be implemented: Unit protocol to include prescribing of nystatin (Nilstat) whenever PD patients are prescribed antibiotics. Patient, GP and staff education to explain that this should occur. Patients will also be given a wallet size card containing the relevant information. A letter to their GP will be sent by the unit nurse for all new PD patients, outlining the need for anti-fungal prescribing. A 1-page checklist will be developed for use when PD patients come to hospital. Duration: A 6 month baseline period has been completed. A 12 month implementation period will start approx. April 2013.
Sponsors
Assoc Prof David Mudge
Study design
Allocation
Non-randomised trial
Intervention model
Single group
Primary purpose
Prevention
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Include all new patients who have had a Tenckhoff catheter inserted (but not yet dialysing) and who experience an infection (exit site, catheter tunnel, post-surgery, peritonitis). Include all new patients undergoing peritoneal dialysis in your unit who experience an infection (exit site, catheter tunnel, post-surgery, peritonitis). Include all new patients who have had a Tenckhoff catheter re-inserted or who have had surgery because of catheter movement and who experience an infection (exit site, catheter tunnel, post-surgery, peritonitis). Include private patients who are included under your unit's ANZDATA returns. Include returning transplant patients. Include patients who have transferred from haemodialysis. Only include patients who are on the chronic dialysis program.
Exclusion criteria
Acute renal failure patients who recover. Patients who have had a Tenckhoff catheter inserted prior to the trial start date and who experience an infection (exit site, catheter tunnel, post-surgery, peritonitis). Patients undergoing peritoneal dialysis in your unit who commenced dialysis prior to the trial start date and who experience an infection (exit site, catheter tunnel, post-surgery, peritonitis).
Outcome results
None listed