None listed
Conditions
Brief summary
Healthcare associated infections (HAI) threaten the safety of patients and cause significant and life-threatening harm to patients and bring major additional costs to already stretched health budgets. Patients with kidney disease are especially susceptible to HAI, and most prominent among these is the harm associated with central venous haemodialysis catheter use. The absence of a systematic approach to the challenges arising from dialysis catheter use means one of the major patient safety challenges in this susceptible patient group remains very real, poorly measured and the subject of large variations in practice. The REDUCCTION Project Objectives: 1. To define the clinical and economic burden of dialysis catheter exposure and bacteraemia across Australia and New Zealand at a facility level 2. To reduce dialysis catheter related bacteraemia through implementation of an evidence-based and systematic intervention package 3. To establish a framework from the evidence implementation project for monitoring dialysis catheter related bacteraemia and sustaining improvements from the intervention phase
Interventions
Stepped cluster wedge randomised implementation project
The Project will be carried out in 4 phases:
Phase I: Study site set up Dec 2015-Aug 2016
Phase II: Baseline data collection Dec 2016-ongoing
Phase III: Implementation (stepped wedge randomisation) April 2018-sept 2019
Phase IV: Post implementation data collection phase Sep 2019-Mar 2020
The individual components of the intervention are broken into three milestones in catheter use:
1. Interventions employed at the time of dialysis catheter
Stepped cluster wedge randomised implementation project The Project will be carried out in 4 phases: Phase I: Study site set up Dec 2015-Aug 2016 Phase II: Baseline data collection Dec 2016-ongoing Phase III: Implementation (stepped wedge randomisation) April 2018-sept 2019 Phase IV: Post implementation data collection phase Sep 2019-Mar 2020 The individual components of the intervention are broken into three milestones in catheter use: 1. Interventions employed at the time of dialysis catheter insertion such as in operating theatres/radiology/renal units/ICU: a. Ensuring hand hygiene at the time of catheter insertion b. Use of full barrier protection at insertion c. Cleansing of the insertion site with antiseptic solution d. Avoidance of the femoral site for catheter insertion e. Preference given to the use of subcutaneously tunnelled catheters 2. Interventions employed during the dialysis catheter maintenance phase by nursing staff on dialysis wards: a. Use of a standardised catheter insertion site dressing technique using topical antimicrobial preparations (+/- intraluminal catheter locks/topical antimicrobial preparations) and standardised frequency of dressing change b. Provision of standardised nurse-delivered training to patients and their caregivers on the importance of catheter care, along with provision of a patient information sheet on dialysis catheter care c. Protocol driven training in the aseptic techniques for connection and disconnection of the catheter for each haemodialysis treatment d. Training and provision of education materials to patients that enhance their skills in managing dialysis catheters 3. Interventions associated with dialysis catheter removal on dialysis wards by nursing and medical staff: a. Ensure the timely removal of catheters when no longer required The Interventions were finalised prior to implementation, and have since been published.
Sponsors
The George Institute for Global health
Study design
Allocation
Randomised controlled trial
Intervention model
Other
Primary purpose
Prevention
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
All patients requiring a NEW central venous catheter for receipt of dialysis for: *Initiation of maintenance haemodialysis *Provision of acute haemodialysis for acute kidney injury (where the care of the dialysis catheter is under the auspices of the participating renal unit) *Interim haemodialysis due to failure of an existing dialysis access (e.g.: failure of peritoneal dialysis, thrombosis of an existing arterio-venous fistula).
Exclusion criteria
Data from any period where the care of catheter is under the auspices of a unit other than the renal unit
Outcome results
None listed