Infection control: Special Challenges in Renal Services

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Infection control Special Challenges in Renal
Services

• Richard Fluck, Consultant Renal Physician, Derby

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Table 1Positive blood cultures 1999-2004 HD
patients
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ProcessSystem review

• Primary prevention reduce reliance on catheters
• Insertion
• Care
• Dressing type
• Frequency
• Training
• Connection technique
• Treatment
• Antibiotic proformas
• Lead nurse
• Weekly infection reviews

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Figure 1 Survival to first Catheter related
infection
P0.02
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Table 2 Tunnelled CRI infections period around
catheter lock implementation
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Table 3 Positive blood cultures 2005 2006 HD
patients post implementation
2005 6 of 17 had tunnelled access at time of
blood culture 2006 6 of 17 had tunnelled access
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Figure 2 Patients with 1 or more infections
and overall bacteraemias as total HD number
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Overall Results

• 2004 CRI 3.7 infections per 1000 catheter days
  (mean tunneled catheter usage 47 per month).
• 2005 CRI 0.12 infections per 1000 catheter day
  (mean tunnelled catheter usage 44 per month).
• Culture negative episodes with a strong clinical
  index of suspicion for CRI did not change between
  2004 and 2005.

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Summary

• Infection is a significant issue
• Morbidity
• Mortality
• It is not inevitable
• It requires a multidisciplinary, multifaceted
  approach
• Zero tolerance
• Monitoring and review
• Clear policies
• Be proactive not reactive or complacent
• www.dh.gov.uk/reducingmrsa