Reasons behind permacath related infection

Permacath Related Infection In Patients Undergoing Dialysis.

As per the data of National Kidney Foundation (2018), more than 10 % of the world population is currently suffering from chronic kidney disease (CKD) and within that millions of individual lose their life because of unavailability to affordable medication. Haemodialysis is the intervention which is used by the healthcare professionals worldwide to treat patients suffering from CKD and are unable to go through surgery and hence, more than 1.5 million people around the world are treated with this intervention every day (National Kidney Foundation 2018). However, usage of haemodialysis and other similar interventions such as Permacath (a plastic tube resembling a jugular catheter, used for dialysis purpose) can lead to bacteremia as well as non-bacteremic infections (Tong et al. 2015). Therefore, the research topic of this assignment will be determining the reason of permacath related infection in patients undergoing dialysis in my dialysis unit. Further after determining the reason, several interventions will be identified using current research articles that can prevent the emergence of permacath related infection in the dialysis unit.

Healthcare and associated infection are major concerns for the world’s best health organizations and for this purpose, the World Health Organization has already published a set of guidelines including patient safety, healthcare professionals hygiene and other aspects that can lead to severe infection inside the healthcare facility (Shafiee and Barkhordari 2013). However, the renal department of any healthcare facility throughout the world has its own concerns and issues related to infection control. This is because the renal department includes dialysis interventions, which requires vascular access for a longer period of time. Zimbudzi (2012) mentions that as the number of inpatients or outpatients who are undergoing dialysis process at the same time, the chances of blood borne microbial infection is higher in such units. There are several facts that can be the reason of increasing infection in dialysis unit such as healthcare facility’s infection control policies, strategies, the attitude of the staff towards self-hygiene and maintaining nursing values so that such infection can be controlled. While determining the relevance of this topic in current researches, the research conducted by Kitrou et al. (2017) should be mentioned, which focuses mainly on the occurrence of bacteremia due to the usage of short term dialysis vascular access for the permanent vascular access and insertion of permacath tubes. Permacath tubes are a piece of plastic tubing which is used for the same purpose as haemodialysis and has a cuff in its structure which works as a barrier to infection. However, the number of people affected with permacath insertion related infection has been increased. More than 18% of the Australians, undergoing haemodialysis has developed infection while catheter insertion (Shafiee and Barkhordari 2013). Therefore, the increasing risk of infection in permacath related dialysis requires detailed research so that the actual reason behind such infection and the type of interventions and preventive measures can be taken against it can be determined. The secondary reason for choosing this topic as a research topic is the increasing number of hospital acquired infection that increases the stay of patients in the facility. Therefore, findings from the research topic analysis can provide interventions, implementation of that can lead to decrease the chances of infection (Chu, Adams and Crawford 2013).

Literature review

The search strategy for this research topic included keywords such as ‘Permanent Central venous catheters’, ‘Permacath dialysis’, ‘permacath’, ‘Hemodialysis (HD) catheter’, ‘catheter related infection’, ‘in dialysis unit’, ‘Blood borne infection’, ‘In people admitted to dialysis unit’ were used. These keywords were searched in the databases such as, PubMed, and Google scholar. Searching these keywords with several combinations such as ‘permacath catheter related infection in dialysis unit of healthcare facility’ generated specific amount of search results and finally from those, research articles were segregated with specific inclusion and exclusion criteria and after that 12 articles were selected that fulfilled the criteria of the proposed research topic. Inclusion and exclusion criteria included usage of permanent catheter for the dialysis purpose in the inpatient as well as outpatient service in the observation of healthcare professionals. Different Boolean operators such as ‘And’, ‘Or’ was used while searching for the research articles over the databases so that with several combination, different number of results can be generated.

In this sections, the research articles collected from the refining search strategy will be analyzed. In e research conducted by Mahmood et al. (2013), the objective of the researchers was to determine the effectiveness of predialysis care in the patients who are undergoing dialysis process using permacath or other central venous catheters and also have the higher chances of acquiring the infections. The research included 120 patients who were divided into sections, a portion of which was given predialysis treatment and others were included for the dialysis process directly. The result of the study determined that 39.3% of patients who were given the dialysis treatment directly had the chances of developing bacterial infection because of the absence of predialysis treatment and precautions. Further, in another research conducted by Chu, Adams and Crawford (2013), the catheter related blood stream infection was assessed in five dialysis units and a nephrology ward in the healthcare facility of Australia. However, in this setting, the researchers were determined to assess the compliance level of healthcare professionals with the Australian practice development framework and using those strategies mentioned in the framework in reducing the number of blood borne infections in patients undergoing dialysis (Nesrallah et al. 2016). This research article mostly focused on hygiene and structural factors if the dialysis unit in preventing the infection related to permanent catheter or permacath among the patients of chosen healthcare facility. The third literature which was analyzed to determine the effect of permanent catheter on the patients, who were at high risk of bacteremia (Fülöp et al. 2017). For this purpose, the researchers inserted permanent catheter in all the 101 patients and then provided them with 21 day course of intravenous antibiotic. For identification of catheter associated bacteremia or CAB, the patients were assessed for blood culture, episodes of bacteremia and the type of intervention applied. Further, the results indicated that only 11 patients did not shown any sign of infection whereas 84 patients developed infection due to the action of bacteria such as gram positive bacteria or staphylococcus aureus and gram negative bacteria (Szerlip et al. 2016). Therefore, the findings from this research identified that due to the direct contact with the blood stream, insertion of parmacath tubing or catheters increases the chances of infection in people undergoing dialysis. However, in an another research study by Wang et al. (2015) indicated towards the fact that conditions such as arteriovenous fistula and insertion of arteriovenous  grafts are also in direct contact with the blood stream however, the rate of infection in patients with permanent catheter was ten times higher than that of the arteriovenous grafts or arteriovenous fistula. This is because the direct access of blood stream though permanent catheters was more than that of the arteriovenous grafts or fistula that leads the patient to severe infection (Vats 2012).

Research gap

However, the abovementioned literatures had their limitations and the present literature gap should be addressed to provide a concise about the interventions that should be applied to decrease the chance of infection due to the insertion of permacath tubes in patients approaching dialysis. The research conducted by Mahmood et al. (2013) was dependent on the convenient sample size and also included only the outpatient services whereas, the number of infections in inpatients going through dialysis is more than that of the outpatient service. On the other hand, on the other hand, the research conducted in the healthcare setting of Australia and the literature gap of including the practice after the insertion of catheter. The researcher should have been included process prior to catheter insertion as it would have provided proper assessment related to the practice of nurses in dialysis unit. Therefore, the research gap of this literature was absence of pre and post insertion of catheter related results that affected the authentication of the results. In the third research conducted by Chu, Adams and Crawford (2013), the scrutiny of patients not possible as maximum of them were discharged from the healthcare facility and were provided a date of reporting, due to which, the authentication of the research hampered as identification of source of infection becomes difficult (Fülöp et al. 2017).  These were the literature gaps present in the above-mentioned research articles. therefore, my research will be centered around the identification of primary reason of permacath related infections in dialysis unit as well as will be targeted to identify the interventions using which, such infection can be prevented.

Conclusion

As the number of people affected with catheter related or permanent catheter related infection are increasing, researches concerning about the reason of such infection should be conducted with infection so that preventive measures can be taken. In this assignment, this research topic was selected and a search strategy was also provided using which supporting researches were collected from multiple databases. Further, using the selected research articles, a literature review was conducted.

References

Chu, G., Adams, K. and Crawford, S., 2013. Improving catheter-related blood stream infection in haemodialysis patients using a practice development framework. Renal Society Australasia J, 9(1), pp.16-21.

Fülöp, T., Tapolyai, M.B., Agarwal, M., Lopez?Ruiz, A., Molnar, M.Z. and Dossabhoy, N.R., 2017. Bedside Tunneled Dialysis Catheter Removal—A Lesson Learned From Nephrology Trainees. Artificial organs, 41(9), pp.810-817.

Kitrou, P.M., Papadimatos, P., Katsanos, K., Spiliopoulos, S., Christeas, N., Petsas, T. and Karnabatidis, D., 2017. Managing the Failing Dialysis Permacath: Results from a 5-year Retrospective Analysis. Hellenic Journal οf Radiology, 2(3).

Mahmood, S.N., Mukhtar, K.N., Iqbal, N. and Umair, S.F., 2013. Pre dialysis care and types of vascular access employed in incident hemodialysis patients: A study from Pakistan. Pakistan journal of medical sciences, 29(3), p.828.

National Kidney Foundation 2018. GLOBAL FACTS: ABOUT KIDNEY DISEASE. Accessed on August 1, 2018. Retrieved from: https://www.kidney.org/kidneydisease/global-facts-about-kidney-disease

Nesrallah, G.E., Mustafa, R.A., MacRae, J., Pauly, R.P., Perkins, D.N., Gangji, A., Rioux, J.P., Steele, A., Suri, R.S., Chan, C.T. and Copland, M., 2013. Canadian Society of Nephrology guidelines for the management of patients with ESRD treated with intensive hemodialysis. American Journal of Kidney Diseases, 62(1), pp.187-198.

Shafiee, A. and Barkhordari, K., 2013. Another side effect of subclavian catheter. Iranian journal of kidney diseases, 7(2), p.101.

Szerlip, M., Kim, R.J., Adeniyi, T., Thourani, V., Babaliaros, V., Bavaria, J., Herrmann, H.C., Anwaruddin, S., Makkar, R., Chakravarty, T. and Rovin, J., 2016. The outcomes of transcatheter aortic valve replacement in a cohort of patients with end?stage renal disease. Catheterization and Cardiovascular Interventions, 87(7), pp.1314-1321.

Tong, S.Y., Davis, J.S., Eichenberger, E., Holland, T.L. and Fowler, V.G., 2015. Staphylococcus aureus infections: epidemiology, pathophysiology, clinical manifestations, and management. Clinical microbiology reviews, 28(3), pp.603-661.

Vats, H.S., 2012. Complications of catheters: tunneled and nontunneled. Advances in chronic kidney disease, 19(3), pp.188-194.

Wang, K., Wang, P., Liang, X., Lu, X. and Liu, Z., 2015. Epidemiology of haemodialysis catheter complications: a survey of 865 dialysis patients from 14 haemodialysis centres in Henan province in China. BMJ open, 5(11), p.e007136.

Zimbudzi, E., 2012. Suitability of chlorhexidine impregnated dressings on dialysis catheters in an acute dialysis setting: Lessons from our experience. International Journal of Infection Control, 8(3).