Abstract
Background Patients with hemodialysis central venous catheters (HD CVCs) are susceptible to health careassociated infections, particularly hemodialysis catheter-related bloodstream infection (HD-CRBSI), which is associated with high mortality and health care costs. There have been few systematic attempts to reduce this
burden and clinical practice remains highly variable. This manuscript will summarize the challenges in preventing HD-CRBSI and describe the methodology of the REDUcing the burden of dialysis Catheter ComplicaTIOns: a National approach (REDUCCTION) trial.
Methods The REDUCCTION trial is a stepped-wedge cluster randomized trial of a suite of clinical interventions aimed at reducing HD-CRBSI across Australia. It clusters the intervention at the renal-service level with implementation randomly timed across three tranches. The primary outcome is the effect of this intervention upon the rate of HD-CRBSI. Patients who receive an HD CVC at a participating renal service are eligible for inclusion. A customized data collection tool allows near-to-real-time reporting of the number of active catheters, total exposure to catheters over time, and rates of HD-CRBSI in each service. The interventions are centered
around the insertion, maintenance, and removal of HD CVC, informed by the most current evidence at the time of
design (mid-2018).
Results A total of 37 renal services are participating in the trial. Data collection is ongoing with results expected in the last quarter of 2020. The baseline phase of the study has collected provisional data on 5385 catheters in 3615 participants, representing 603,506 days of HD CVC exposure.
Conclusions The REDUCCTION trial systematically measures the use of HD CVCs at a national level in Australia, accurately determines the rate of HD-CRBSI, and tests the effect of a multifaceted, evidence-based intervention upon the rate of HD-CRBSI. These results will have global relevance in nephrology and other specialties commonly using CVCs
burden and clinical practice remains highly variable. This manuscript will summarize the challenges in preventing HD-CRBSI and describe the methodology of the REDUcing the burden of dialysis Catheter ComplicaTIOns: a National approach (REDUCCTION) trial.
Methods The REDUCCTION trial is a stepped-wedge cluster randomized trial of a suite of clinical interventions aimed at reducing HD-CRBSI across Australia. It clusters the intervention at the renal-service level with implementation randomly timed across three tranches. The primary outcome is the effect of this intervention upon the rate of HD-CRBSI. Patients who receive an HD CVC at a participating renal service are eligible for inclusion. A customized data collection tool allows near-to-real-time reporting of the number of active catheters, total exposure to catheters over time, and rates of HD-CRBSI in each service. The interventions are centered
around the insertion, maintenance, and removal of HD CVC, informed by the most current evidence at the time of
design (mid-2018).
Results A total of 37 renal services are participating in the trial. Data collection is ongoing with results expected in the last quarter of 2020. The baseline phase of the study has collected provisional data on 5385 catheters in 3615 participants, representing 603,506 days of HD CVC exposure.
Conclusions The REDUCCTION trial systematically measures the use of HD CVCs at a national level in Australia, accurately determines the rate of HD-CRBSI, and tests the effect of a multifaceted, evidence-based intervention upon the rate of HD-CRBSI. These results will have global relevance in nephrology and other specialties commonly using CVCs
| Original language | English |
|---|---|
| Pages (from-to) | 746-754 |
| Number of pages | 34 |
| Journal | Kidney360 |
| Volume | 1 |
| Issue number | 8 |
| DOIs | |
| Publication status | Published - 1 Aug 2020 |
Bibliographical note
Funding Information:The REDUcing the burden of dialysis Catheter ComplicaTIOns: a National approach (REDUCCTION) trial is supported by National Health and Medical Research Council (partnership grant APP1103241), Department of Health Victoria, and Queensland Health. The Australia and New Zealand Dialysis and Transplant Registry, Kidney Health Australia, Kidney Health Australia–Caring for Australasians with Renal Impairment, Alice Springs Hospital, Royal Darwin Hospital, Royal Adelaide Hospital, Austin Hospital, Alfred Hospital, Eastern health, Monash Medical Centre, Royal Melbourne Hospital, Western Health, Royal Hobart Hospital, Cairns Hospital, Princess Alexandria Hospital, Royal Brisbane Hospital, Sunshine Coast Hospital and Health Service, Toowoomba Hospital, Australian Capital Territory/New South Wales Southern Highlands Local District Renal Network, Concord Repatriation General Hospital, Royal Prince Alfred Hospital, Liverpool Hospital, Nepean Hospital, and the Western Sydney Local Health District provided in-kind support. S. Kotwal is supported by the Department of Health, Australian Government via Medical Research Future Fund Next-Generation Translating Research into Practice Fellowship (MRF1150335).
Funding Information:
N. Gray reports personal fees from Baxter Healthcare and nonfinancial support from Amgen Australia outside the submitted work. M. Gallagher reports grants from Australian National Health and Medical Research Council, nonfinancial support from Multiple partner hospitals, grants from Victorian Department of Health, and grants from Queensland Department of Health during the conduct of the study; the George Institute and its affiliated entities work with numerous health and pharmaceutical companies in the design, implementation, and analyses of clinical research and clinical trials. It is possible that some of these companies have products relevant to the clinical space covered in this analysis, but Dr. Gallagher is not aware of any possible conflicts arising from this work. All remaining authors have nothing to disclose.
Publisher Copyright:
Copyright © 2020 by the American Society of Nephrology.