P174
PILOT AUDIT OF OCTENILIN WOUND IRRIGATION SOLUTION ON
PERITONEAL DIALYSIS EXIT SITES
Vaz, G
Kings College Hospital
BACKGROUND:
Peritonitis and Exit Site Infection (ESI) complications are the leading cause of peritoneal dialysis catheter failure in renal patients. Hand hygiene, exit site cleaning and dressing techniques, and antimicrobial use are all longstanding and common practices used to try and prevent complications. Currently our main problem organisms that cause exit site infections are staphylococcus epidermis, staphylococcus areus and pseudomonas aeruginosoa.
A recent and more controversial area, is the use of topical creams to prevent exit site infections. The ISPD guidelines (2010) suggest a topical treatment should be applied to prevent and treat both staphylococcal and pseudomonas infections. Currently several PD units use either saline or alcohol to clean exit sites and mupirocin or gentamycin cream to provide antimicrobial cover. However this can leave the area warm and moist, which can encourage organism growth and contamination.
AIM:
To test a wound irrigating product (Octenilin®) as an exit site cleanser and antibacterial in a group of PD patients to prevent staph areus, staph epi and pseumonal infections.
METHOD:
An audit was conducted over 6 months with 15 patients with PD catheters to trial the effectiveness of Octenilin wound irrigation solution on PD exit sites. The 15 patients were randomly chosen and gave consent to take part. This included 10 newly created healed exit sites and 5 non-infected established exit sites. The patients were monitored 4 weekly using the
Twardowski & Prowant (1996) scoring system. Each patient was screened for MRSA and exit site swabs were taken prior to commencing the use of Octenilin.
RESULTS:
Organism
Staphylococcus Epidermis
2011 Jan-Aug 2012 Jan-Aug
6 1
Staphylococcus Areus
Pseudomonas
Proteus
Mixed Anerobes
Klebsiella
8
8
4
2
3
1
4
1
1
2
Anerobic Streptococcus 1 1
Enterobacter
Acinetobacter
4
2
1
1
Yeast/Candida 2 0
A table to show the organisms found infecting exit sites during the audit period (6 months) in
2012 (with 15 patients using Octenilin) compared to the same 6 months in 2011 (without patients using Octenilin).
CONCLUSION:
These findings show Octenilin significantly reduced staphylococcal and pseudomonal exit site infections. The results were discussed at our academic meeting with the multi-disciplinary team, and whilst the sample size was small, the findings showed a decrease in exit site infection significant enough to allow trial use in the whole PD population in our unit.
Octenilin is being distributed amongst all our PD patients and we are auditing their outcomes.