Developing a CQI Model to Identify Best Practices in Hemodialysis Catheter Care Using a 2% Chlorhexidine (CHG) and 70% Isopropyl Alcohol (IPA) No Touch Applicator

Balovlenkov EK. Developing a CQI model to identify best practices in hemodialysis catheter care using a 2% chlorhexidine (CHG) and 70% isopropyl alcohol (IPA) no touch applicator. Nephrol Nurse J. 2004;31:139-140

Rationale
Hemodialysis catheters are known to increase the risk of bloodstream infections. Reducing the risk of dialysis-associated bloodstream infections would significantly improve patient outcomes.

Objective
To determine techniques that will help reduce infections associated with dialysis while protecting natural skin flora. ChloraPrep®, a 2% chlorhexidine (CHG) and 70% isopropyl alcohol (IPA) formulation, and a transparent dressing were evaluated and compared with povidone iodine (PVI) and a gauze dressing, PVI and a transparent dressing, and PVI and a nontransparent antimicrobial polyhexamethylene biguanide (PHMB) dressing.

Design
One hundred fifty patients were assessed. Criteria used to evaluate products included ease of use, patient satisfaction, staff satisfaction, nursing time, bloodstream infection rates, and cost. Sensitivity to ChloraPrep®, PVI, and PHMB were also taken into account.

Methods

  • Each dressing was evaluated for 30 days
  • All patients using PVI dressings had three dressing changes per week
  • All patients using ChloraPrep had one dressing change unless the dressing was soiled or nonadhering, or the patient requested a dressing change
  • At each dressing change, staff completed a nine-item questionnaire and examined catheter exit sites and surrounding areas for signs of irritation, inflammation, pain, or infection, including bloodstream infection

 

Results
In comparison with the other dressing techniques employed in the study, use of ChloraPrep and a transparent dressing resulted in the following:

  • Increased staff and patient satisfaction
  • Reduced nursing time
  • Decreased cost
  • Bloodstream infection rates within thresholds

 

Conclusion
ChloraPrep and a transparent dressing is the best practice recommended for hemodialysis catheter site care.

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