G12(Th)
CAN DIALYSIS CATHETER COLONISATION BE SIGNIFICANTLY REDUCED IF
THE CATHETER CARE BUNDLE IS APPLIED COMPREHENSIVELY?
Nicholas, J, Oh, W, Cooper, M, Dobie, D
Newcross Hospital, Wolverhampton
BACKGROUND: Catheter associated infections(CAI) remains a significant cause of morbidity
and mortality in the haemodialysis population. Measures taken by our renal unit and hospital
since 2006 (catheter care bundle, clean hospital policy ) have led to a significant reduction in the
incidence of CAIs. Despite the success of these measures, the incidence of catheter tip
colonisation remained unknown. Previous studies have shown a linear correlation between
catheter tip colonisation and catheter-related bacteraemia. In the setting of low CAI rates, we
report the incidence of catheter tip colonisation in our haemodialysis population.
METHODS: All catheter tips from haemodialysis catheters routinely removed over a three
month period were cultured to confirm colonisation. The total number of catheters, the site of
their placement , the number of colonised catheters and the type of organisms identified have
been recorded. It has been the policy of the centre to use tunnelled catheters (TC) in all patients
and avoid the prolonged use (>3 days) of non-tunnelled lines for dialysis.
RESULTS: Over the three month period, there were 149 catheter insertions (TC – 74.5%) ,119
catheter removals and there were 11 CAIs noted (CAI rate of 1.1 episodes/1000 catheter days,
range 0.27 to 2.32 ), with past CAI rates (years 2004 – 2005) being between 2 and 6/1000
catheter days, dropping to less than 0.5/1000 catheter days by 2009. Not all CAIs required
catheter removal. A total of 86 catheters were removed and the tips were cultured (56% male).
81% of the catheters removed (CR) were TCs. Of the CR cases: 7% were due to CAIs, 41%
catheter dysfunction; 19% recovered renal function; 10% switched to peritoneal dialysis; 8%
had non-tunnelled catheters (NTC) removed and required TCs placed; 14% had functioning
arteriovenous fistulas and 1% had to withdraw from haemodialysis.
In total, 17 (19.7%) of catheter tips were colonised (82.4 % TC, 17.6% NTC). 41% of the
colonised catheters were removed from the femoral vein and 59% were removed from the
internal jugular vein. The risk of colonisation for TC (OR 1.08) and NTC (OR 1.09) were
similar. Of the 17 colonised catheters, 5 were in CAI cases and 12 were not. There was one
case of a CAI (with a severe track infection) without colonisation and 68 with no colonisation at
all (specificity- 85%, sensitivity 83.3%). Of the 5 infected and colonised catheters: 40% were
femoral catheters and 60% internal jugular catheters, with 20% NTC. 5(71%) out of 7 femoral
catheters were colonised by gram negative organisms. 8 (80%) out of 10 internal jugular
catheters were colonised by gram positive organisms and skin flora.
CONCLUSION: Past literature indicated that catheter colonisation was unavoidable and
bacteraemia was common. The steps taken in this hospital to combat CAIs has led to infection
and colonisation rates which are lower compared with published data (CAIs –9.2/1000 catheter
days, colonisation 50.9%).
IMPLICATIONS: These measures should be adopted by all centres to minimise CAI and
improve patient outcomes.