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ISPD guideline-driven retraining, exit site care and decreased peritonitis: a single-center experience in Israel

  • Nephrology - Original Paper
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Abstract

Purpose

Evaluate the efficacy of retraining and catheter exit site care in reducing peritonitis rates.

Methods

This interventional study included all prevalent PD patients from 1/2009 to 12/2017 from a single center. Peritonitis rates and causative organisms were assessed and compared in three periods: (1) Before intervention (01/2009–12/2014), (2) after educational intervention: assessment of training process by infection control nurse and repeat training every 3 months, after each peritonitis episode and after hospitalizations > 2 weeks (01/2015–02/2016), and (3) in addition to the measures in period 2, an exit site care protocol including postoperative care, topical antibacterial therapy and nasal Staph aureus screening and eradication was implemented (03/2016–12/2017).

Results

The study included 201 patients (149 men, 52 women), mean age was 65.1 ± 12.6 years. After both interventions, including educational and exit site care strategies, peritonitis decreased significantly from 1.05 episodes per patient-year (n = 113) to 0.67 (n = 54); P = 0.017 between periods 1 and 3. The percentage of peritonitis-free patients increased from 27.4 to 52.4 and 55.6%, respectively (P = 0.001 between period 1 vs. 2 and period 1 vs. 3.). Coagulase-negative staph was the most common pathogen, causing 7.56 peritonitis episodes per year, followed by pseudomonas at 4.33 episodes annually and staph aureus at 3.44 episodes per year.

Conclusions

Enforcement of an educational program and strict adherence to an exit site care protocol was associated with a significant decrease in peritonitis rates.

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Authors and Affiliations

  1. Department of Nephrology and Hypertension, Meir Medical Center, 44281, Kfar Saba, Israel

    Yael Einbinder, Keren Cohen-Hagai, Tali Zitman-Gal, Daniel Erez, Sydney Benchetrit, Ze’ev Korzets & Andy Kotliroff

  2. Infection Control Unit, Meir Medical Center, 44281, Kfar Saba, Israel

    Pnina Shitrit

  3. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    Yael Einbinder, Keren Cohen-Hagai, Pnina Shitrit, Tali Zitman-Gal, Daniel Erez, Sydney Benchetrit, Ze’ev Korzets & Andy Kotliroff

Authors
  1. Yael Einbinder
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  2. Keren Cohen-Hagai
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Correspondence to Yael Einbinder.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Einbinder, Y., Cohen-Hagai, K., Shitrit, P. et al. ISPD guideline-driven retraining, exit site care and decreased peritonitis: a single-center experience in Israel. Int Urol Nephrol 51, 723–727 (2019). https://doi.org/10.1007/s11255-019-02100-w

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  • DOI: https://doi.org/10.1007/s11255-019-02100-w

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