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Multifaceted intervention to reduce haemodialysis catheter related bloodstream infections- REDUCCTION stepped wedge, cluster randomised trial439.86 kB
Published VersionCC BY V4.0, Open Access
Journal article
Multifaceted intervention to reduce haemodialysis catheter related bloodstream infections: REDUCCTION stepped wedge, cluster randomised trial
BMJ, Vol.377, pp.1-8
2022
PMID: 35414532
Abstract
Objective: To identify whether multifaceted interventions, or care bundles, reduce catheter related bloodstream infections (CRBSIs) from central venous catheters used for haemodialysis.
Design: Stepped wedge, cluster randomised design.
Setting: 37 renal services across Australia.
Participants: All adults (age ≥18 years) under the care of a renal service who required insertion of a new haemodialysis catheter.
Interventions: After a baseline observational phase, a service-wide, multifaceted intervention bundle that included elements of catheter care (insertion, maintenance, and removal) was implemented at one of three randomly assigned time points (12 at the first time point, 12 at the second, and 13 at the third) between 20 December 2016 and 31 March 2020.
Main outcomes measure: The primary endpoint was the rate of CRBSI in the baseline phase compared with intervention phase at the renal service level using the intention-to-treat principle.
Results: 1.14 million haemodialysis catheter days of use were monitored across 6364 patients. Patient characteristics were similar across baseline and intervention phases. 315 CRBSIs occurred (158 in the baseline phase and 157 in the intervention phase), with a rate of 0.21 per 1000 days of catheter use in the baseline phase and 0.29 per 1000 days in the intervention phase, giving an incidence rate ratio of 1.37 (95% confidence interval 0.85 to 2.21; P=0.20). This translates to one in 10 patients who undergo dialysis for a year with a catheter experiencing an episode of CRBSI.
Conclusions: Among patients who require a haemodialysis catheter, the implementation of a multifaceted intervention did not reduce the rate of CRBSI. Multifaceted interventions to prevent CRBSI might not be effective in clinical practice settings.
Trial registration: Australia New Zealand Clinical Trials Registry ACTRN12616000830493.
Details
- Title
- Multifaceted intervention to reduce haemodialysis catheter related bloodstream infections: REDUCCTION stepped wedge, cluster randomised trial
- Authors
- Sradha Kotwal (Author) - The George Institute for Global HealthAlan Cass (Author) - Charles Darwin UniversitySarah Coggan (Author) - UNSW AustraliaNicholas Gray (Author) - University of the Sunshine Coast, Queensland, School of Health and Behavioural Sciences - LegacyStephen Jan (Author) - UNSW AustraliaStephen McDonald (Author) - The University of AdelaideKevan R Polkinghorne (Author) - Monash UniversityKris Rogers (Author) - UNSW AustraliaGirish Talaulikar (Author) - Act HealthGian Luca Di Tanna (Author) - UNSW AustraliaMartin Gallagher (Author) - UNSW Australiaon behalf of the REDUCCTION Investigators (Research Group)
- Publication details
- BMJ, Vol.377, pp.1-8
- Publisher
- B M J Group
- Date published
- 2022
- DOI
- 10.1136/bmj-2021-069634
- ISSN
- 1756-1833; 0959-535X
- PMID
- 35414532
- Copyright note
- This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/.
- Organisation Unit
- UniSC Clinical Trials Centre; University of the Sunshine Coast, Queensland; School of Health and Behavioural Sciences - Legacy
- Language
- English
- Record Identifier
- 99629437202621
- Output Type
- Journal article
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