Long-term follow-up of the Hemodialysis Infection Prevention with Polysporin
Ointment (HIPPO) Study: a quality improvement report.
Author(s): Battistella M, Bhola C, Lok CE.
Affiliation(s): University Health Network-Toronto General Hospital, Toronto, Ontario, Canada.
Publication date & source: 2011, Am J Kidney Dis. , 57(3):432-41
BACKGROUND: Infection is a common and serious complication in hemodialysis
patients accessed using central venous catheters (CVCs). Previously, a randomized
double-blinded trial (HIPPO [Hemodialysis Infection Prevention With Polysporin
Ointment] Study) showed that application of a topical polyantibiotic ointment at
the CVC exit site decreased CVC-related infections, including bacteremias and
their adverse consequences. Based on this study's results, our institution
implemented a policy of routine topical polyantibiotic ointment application for
CVC-related infection prophylaxis. The main purpose of this prospective
observational study was to determine whether the low rate of CVC-related
infection achieved by topical polyantibiotic ointment use during a randomized
controlled trial would be observed during long-term prophylaxis as part of
routine clinical care.
STUDY DESIGN: Quality improvement report.
SETTING & PARTICIPANTS: All adult long-term hemodialysis patients using a
tunneled cuffed CVC in a large university-affiliated outpatient hemodialysis
program in 2004-2009 were included.
QUALITY IMPROVEMENT PLAN: To prospectively monitor the impact of a policy-wide
strategy of topical polyantibiotic ointment application at CVC exit sites (1
time/wk) as infection prophylaxis. A multidisciplinary team approach to the
surveillance, prospective tracking, and management of hemodialysis CVC-related
infection was used.
OUTCOMES & MEASUREMENTS: Rates of CVC-related infections (exit-site
infections and bacteremias), percentages of contributing organisms, and
consequences of CVC-related infections.
RESULTS: After 6 years, CVC exit-site infection and bacteremia rates remained low
(<1.0/1,000 catheter-days). Gram-positive organisms accounted for 61.2% of
exit-site infections and 72.1% of bacteremias.
LIMITATIONS: A center effect of the same institution conducting the randomized
trial and the quality improvement study may limit the study's generalizability to
other centers. The impact of possible unmeasured cointerventions cannot be
excluded.
CONCLUSION: Long-term use of topical antibiotic application at CVC exit sites
resulted in a sustained decrease in all CVC-related infections. A
multidisciplinary effort to monitor and track outcomes allowed safe and effective
implementation of a new prophylactic strategy.
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