Multifaceted intervention to reduce haemodialysis catheter related bloodstream infections: REDUCCTION stepped wedge, cluster randomised trial.

Kotwal, S; Cass, A; Coggan, S; Gray, NA; Jan, S; McDonald, S; Polkinghorne, KR; Rogers, K; Talaulikar, G; Di Tanna, GL; Gallagher, M; REDUCCTION Investigators,

Multifaceted intervention to reduce haemodialysis catheter related bloodstream infections: REDUCCTION stepped wedge, cluster randomised trial.

Kotwal, S Cass, A Coggan, S Gray, NA Jan, S McDonald, S Polkinghorne, KR Rogers, K

Talaulikar, G Di Tanna, GL Gallagher, M REDUCCTION Investigators,

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Publisher:: BMJ Publishing Group
Publication Type:: Journal Article
Citation:: BMJ: British Medical Journal, 2022, 377, pp. 1-8
Issue Date:: 2022-04-12

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Field	Value	Language
dc.contributor.author	Kotwal, S
dc.contributor.author	Cass, A
dc.contributor.author	Coggan, S
dc.contributor.author	Gray, NA
dc.contributor.author	Jan, S
dc.contributor.author	McDonald, S
dc.contributor.author	Polkinghorne, KR
dc.contributor.author	Rogers, K https://orcid.org/0000-0001-5497-4298
dc.contributor.author	Talaulikar, G
dc.contributor.author	Di Tanna, GL
dc.contributor.author	Gallagher, M
dc.contributor.author	REDUCCTION Investigators,
dc.date.accessioned	2022-10-14T02:12:44Z
dc.date.available	2022-10-14T02:12:44Z
dc.date.issued	2022-04-12
dc.identifier.citation	BMJ: British Medical Journal, 2022, 377, pp. 1-8
dc.identifier.issn	0959-535X
dc.identifier.issn	1756-1833
dc.identifier.uri	http://hdl.handle.net/10453/162585
dc.description.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.
dc.format	Electronic
dc.language	eng
dc.publisher	BMJ Publishing Group
dc.relation.ispartof	BMJ: British Medical Journal
dc.relation.isbasedon	10.1136/bmj-2021-069634
dc.rights	info:eu-repo/semantics/openAccess
dc.subject	1103 Clinical Sciences, 1117 Public Health and Health Services
dc.subject.classification	General & Internal Medicine
dc.subject.mesh	Adolescent
dc.subject.mesh	Adult
dc.subject.mesh	Catheter-Related Infections
dc.subject.mesh	Central Venous Catheters
dc.subject.mesh	Humans
dc.subject.mesh	Incidence
dc.subject.mesh	Renal Dialysis
dc.subject.mesh	Sepsis
dc.subject.mesh	Adolescent
dc.subject.mesh	Adult
dc.subject.mesh	Catheter-Related Infections
dc.subject.mesh	Central Venous Catheters
dc.subject.mesh	Humans
dc.subject.mesh	Incidence
dc.subject.mesh	Renal Dialysis
dc.subject.mesh	Sepsis
dc.subject.mesh	Humans
dc.subject.mesh	Sepsis
dc.subject.mesh	Renal Dialysis
dc.subject.mesh	Incidence
dc.subject.mesh	Adolescent
dc.subject.mesh	Adult
dc.subject.mesh	Catheter-Related Infections
dc.subject.mesh	Central Venous Catheters
dc.title	Multifaceted intervention to reduce haemodialysis catheter related bloodstream infections: REDUCCTION stepped wedge, cluster randomised trial.
dc.type	Journal Article
utslib.citation.volume	377
utslib.location.activity	England
utslib.for	1103 Clinical Sciences
utslib.for	1117 Public Health and Health Services
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Health
pubs.organisational-group	/University of Technology Sydney/Faculty of Health/Public Health
utslib.copyright.status	open_access	*
pubs.consider-herdc	false
dc.date.updated	2022-10-14T02:12:43Z
pubs.publication-status	Published
pubs.volume	377

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.

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http://hdl.handle.net/10453/162585