Optimizing exit-site care for hospitalized peritoneal dialysis patients with weekly chlorhexidine-impregnated dressing.

Abstract

IntroductionPeritoneal dialysis (PD) catheter exit site care is crucial to prevent exit site or tunnel tract infection. Daily exit site care for hospitalized PD patients can be time-consuming for nurses. Therefore, an alternative approach with less frequent exit site care is needed.MethodsThe quality improvement (QI) initiative was conducted at a single center in Singapore from August 2021 to February 2022, during the COVID-19 pandemic. This initiative aimed to reduce nursing time spent on exit site care for hospitalized PD patients using weekly chlorhexidine-impregnated sponge dressings.ResultsA total of 211 PD patients received weekly chlorhexidine-impregnated dressings during their admission. The total length of stay was 3714 days, with a median stay of 6 (interquartile range: 3-13) days per patient. Most patients were Chinese (78%), and 59% were male. PD nurses spent a median of 104.9 min (Interquartile range [IQR]: 99.3-129.7) per patient per month on exit-site care with daily antibiotic dressing before this initiative. After the QI initiative, this was reduced to 31.3 min (IQR: 26.6-31.6), achieving a 70% reduction. A total of 696 chlorhexidine dressings were used, instead of an estimated 3714 conventional dressings. Nursing time for dressing changes was 116 h with chlorhexidine, versus an assumed 619 h with conventional daily dressing, resulting in a net saving of 503 h. The total cost for chlorhexidine dressings was Singapore Dollars (S$) 20,880, compared to estimated S$ 74,280 for conventional dressings, yielding a net savings of S$ 53,400. No patients developed exit-site infections, and no adverse events were observed with the chlorhexidine dressings.ConclusionsThe QI initiative showed that weekly chlorhexidine-impregnated dressing significantly reduced nursing time for exit-site care in hospitalized PD patients without short-term adverse events, potentially lowering healthcare costs.