Comparison of vascular access infection incidence of hemodialysis patients during epidemic and non-epidemic period of COVID-19_West China Medical Journal

Authors：

ZHANG Bing ¹ , SHI Lingzhi ² , HUA Junfei ² ,  MAO Yiping ¹

1. Department of Infection Management, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangshu 221000, P. R. China;
2. Department of Blood Purification Center, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangshu 221000, P. R. China;

Corresponding author：

MAO Yiping, Email: 385524376@qq.com

Keywords：

COVID-19; hemodialysis; access related bloodstream infection; local access site infection

DOI：

10.7507/1002-0179.202308011

Video：

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Objective To explore the vascular access infection (VAI) incidence of hemodialysis patients during the the maximum spread of the COVID-19 epidemic (epidemic period) compared with the corresponding period with no local cases of COVID-19 (control period). Methods A single-center, retrospective study was carried out. Adult patients who underwent hemodialysis at the Department of Blood Purification Center, the Affiliated Hospital of Xuzhou Medical University during the epidemic period between December 7, 2022 and February 23, 2023 and the control period between December 7, 2020 and February 23, 2021 were selected. The incidence of local access site infection (LASI) and access related bloodstream infection (ARBSI) in included patients were observed and compared. Results A total of 1 401 patients were included. Among them, there were 737 cases during the epidemic period and 664 cases during the control period. There was no statistically significant difference in the age, gender, and duration of catheterization among patients of different periods and pathway types (P>0.05). There was no statistically significant difference in the occurrence of LASI between the epidemic period and the control period (χ²=1.800, P=1.180). There was a statistically significant difference in the occurrence of ARBSI between the epidemic period and the control period [χ²=4.610, relative risk (RR)=2.575, 95% confidence interval (CI) (1.053, 6.298), P=0.032]. There was no statistically significant difference in the incidence of LASI and ARBSI at different stages in patients with arteriovenous fistula and unnel-cuffed catheters (TCC) (P＞0.05). There were statistically significant differences in the incidence of LASI [χ²=4.898, RR=3.832, 95%CI (1.058, 13.885), P=0.027] and ARBSI [χ²=7.150, RR=4.684, 95%CI (1.333, 16.460), P=0.005] among non cuffed catheters (NCC) patients at different stages. TCC patients might experience LASI (P<0.05) during the epidemic period and ARBSI (P<0.05) during the control period compared with the arteriovenous fistula patients; both central venous catheterization and NCC patients might experience LASI and ARBSI during the control period (P<0.05). Conclusion Targeting COVID-19 prevention may be associated with the reduction of vascular access infection in hemodialysis patients, in particular in NCC patients.

Citation： ZHANG Bing, SHI Lingzhi, HUA Junfei, MAO Yiping. Comparison of vascular access infection incidence of hemodialysis patients during epidemic and non-epidemic period of COVID-19. West China Medical Journal, 2023, 38(12): 1874-1879. doi: 10.7507/1002-0179.202308011 Copy

1.	Rteil A, Kazma JM, El Sawda J, et al. Clinical characteristics, risk factors and microbiology of infections in patients receiving chronic hemodialysis. J Infect Public Health, 2020, 13(8): 1166-1171.
2.	Kumbar L, Yee J. Current concepts in hemodialysis vascular access infections. Adv Chronic Kidney Dis, 2019, 26(1): 16-22.
3.	Saran R, Robinson B, Abbott KC, et al. US renal data system 2019 annual data report: epidemiology of kidney disease in the United States. Am J Kidney Dis, 2020, 75(1Suppl 1): A6-A7.
4.	Heidempergher M, Sabiu G, Orani MA, et al. Targeting COVID-19 prevention in hemodialysis facilities is associated with a drastic reduction in central venous catheter-related infections. J Nephrol, 2021, 34(2): 345-353.
5.	Johansen KL, Gilbertson DT, Wetmore JB, et al. Catheter-associated bloodstream infections among patients on hemodialysis: progress before and during the COVID-19 pandemic. Clin J Am Soc Nephrol, 2022, 17(3): 429-433.
6.	吴悦, 孙潇潇, 周晓琪, 等. 新疫情防控形势下广州某三甲医院住院病人新型冠状病毒感染率及分析. 中山大学学报(医学科学版), 2023, 44(5): 878-885.
7.	Centers for Disease Control and Prevention, National Healthcare Safety Network (NHSN). Dialysis Event Surveillance Protocol, 2023.
8.	Fisher M, Golestaneh L, Allon M, et al. Prevention of bloodstream infections in patients undergoing hemodialysis. Clin J Am Soc Nephrol, 2020, 15(1): 132-151.
9.	郭舒婕, 常玉兰, 杨巧芳, 等. 医务人员对新型冠状病毒肺炎防护认知及行为的调查研究. 中华护理杂志, 2020, 55(S1): S736-S740.
10.	陈丽明. 新冠疫苗接种态度及其社会心理影响因素的调查. 生命科学仪器, 2022, 20(S1): 121, 124.
11.	张丽伟, 狄佳, 江淑芳, 等. 对医护人员在新冠感染疫情期间的认知态度和行为调查研究. 中国医疗管理科学, 2021, 11(1): 66-71.
12.	Jabarpour M, Dehghan M, Afsharipour G, et al. The impact of COVID-19 outbreak on nosocomial infection rate: a case of Iran. Can J Infect Dis Med Microbiol, 2021, 2021: 6650920.
13.	王瑶, 王征, 张双龙, 等. 新型冠状病毒肺炎疫情下非定点医院重症监护病房的医院感染管理. 中国中西医结合急救杂志, 2020, 27(5): 562-565.
14.	王国兴, 李银芝, 李敏, 等. 新型冠状病毒肺炎疫情防控期间高压氧病房医院感染现状: 单中心报告. 中华航海医学与高气压医学杂志, 2021, 28(5): 656-658.
15.	付雪松, 曾惠敏, 张霁, 等. 新冠疫情期间肿瘤医院住院患者医院感染及相关因素分析. 医院管理论坛, 2021, 38(2): 60-62,36.
16.	Maes M, Higginson E, Pereira-Dias J, et al. Ventilator-associated pneumonia in critically ill patients with COVID-19. Crit Care, 2021, 25(1): 25.
17.	Basile C, Combe C, Pizzarelli F, et al. Recommendations for the prevention, mitigation and containment of the emerging SARS-CoV-2 (COVID-19) pandemic in haemodialysis centres. Nephrol Dial Transplant, 2020, 35(5): 737-741.
18.	国家肾病学专业医疗质量管理与控制中心, 国家慢性肾病临床医学研究中心, 肾脏疾病国家重点实验室. 新型冠状病毒肺炎疫情防控期间血液透析质控专家共识. 中华医学杂志, 2022, 102(26): 1982-1986.
19.	Knudsen AR, Kolle S, Hansen MB, et al. Effectiveness of an electronic hand hygiene monitoring system in increasing compliance and reducing healthcare-associated infections. J Hosp Infect, 2021, 115: 71-74.
20.	安敏, 曹虎男, 戴小梅, 等. 急性肾损伤患者连续性肾脏替代治疗两种连接引血方式对血流动力学影响的研究. 中华急危重症护理杂志, 2023, 4(10): 869-874.
21.	Shimohata T, Mawatari K, Uebanso T, et al. Bacterial contamination of hemodialysis devices in hospital dialysis wards. J Med Invest, 2019, 66(1/2): 148-152.
22.	Novosad SA, Lake J, Nguyen D, et al. Multicenter outbreak of gram-negative bloodstream infections in hemodialysis patients. Am J Kidney Dis, 2019, 74(5): 610-619.
23.	Amarsy R, Fournier S, Trystram D, et al. Decrease of hospital- and community-acquired bloodstream infections due to Streptococcus pneumoniae and Streptococcus pyogenes during the first year of the COVID-19 pandemic: a time-series analysis in Paris region. Am J Infect Control, 2023, 51(4): 475-477.
24.	Farrington CA, Allon M. Management of the hemodialysis patient with catheter-related bloodstream infection. Clin J Am Soc Nephrol, 2019, 14(4): 611-613.
25.	Kotwal S, Cass A, Coggan S, et al. Multifaceted intervention to reduce haemodialysis catheter related bloodstream infections: REDUCCTION stepped wedge, cluster randomised trial. BMJ, 2022, 377: e069634.
26.	Mohamed H, Ali A, Browne LD, et al. Determinants and outcomes of access-related blood-stream infections among irish haemodialysis patients, a cohort study. BMC Nephrol, 2019, 20(1): 68.
27.	Brown RS, Brickel K, Davis RB. Two-Year Observational Study of Bloodstream Infection Rates in Hemodialysis Facility Patients with and without Catheters. Clin J Am Soc Nephrol, 2018, 13(9): 1381-1388.
28.	Hasanoglu I, Guner R, Sahin S, et al. Surveillance of hemodialysis related infections: a prospective multicenter study. Sci Rep, 2020, 12(1): 22240.
29.	Demirci R, Sahtiyancı B, Bakan A, et al. The predictors of catheter-related bloodstream infections in patients undergoing hemodialysis: a single center experience. J Vasc Access, 2023, 24(1): 76-81.

1. Rteil A, Kazma JM, El Sawda J, et al. Clinical characteristics, risk factors and microbiology of infections in patients receiving chronic hemodialysis. J Infect Public Health, 2020, 13(8): 1166-1171.
2. Kumbar L, Yee J. Current concepts in hemodialysis vascular access infections. Adv Chronic Kidney Dis, 2019, 26(1): 16-22.
3. Saran R, Robinson B, Abbott KC, et al. US renal data system 2019 annual data report: epidemiology of kidney disease in the United States. Am J Kidney Dis, 2020, 75(1Suppl 1): A6-A7.
4. Heidempergher M, Sabiu G, Orani MA, et al. Targeting COVID-19 prevention in hemodialysis facilities is associated with a drastic reduction in central venous catheter-related infections. J Nephrol, 2021, 34(2): 345-353.
5. Johansen KL, Gilbertson DT, Wetmore JB, et al. Catheter-associated bloodstream infections among patients on hemodialysis: progress before and during the COVID-19 pandemic. Clin J Am Soc Nephrol, 2022, 17(3): 429-433.
6. 吴悦, 孙潇潇, 周晓琪, 等. 新疫情防控形势下广州某三甲医院住院病人新型冠状病毒感染率及分析. 中山大学学报(医学科学版), 2023, 44(5): 878-885.
7. Centers for Disease Control and Prevention, National Healthcare Safety Network (NHSN). Dialysis Event Surveillance Protocol, 2023.
8. Fisher M, Golestaneh L, Allon M, et al. Prevention of bloodstream infections in patients undergoing hemodialysis. Clin J Am Soc Nephrol, 2020, 15(1): 132-151.
9. 郭舒婕, 常玉兰, 杨巧芳, 等. 医务人员对新型冠状病毒肺炎防护认知及行为的调查研究. 中华护理杂志, 2020, 55(S1): S736-S740.
10. 陈丽明. 新冠疫苗接种态度及其社会心理影响因素的调查. 生命科学仪器, 2022, 20(S1): 121, 124.
11. 张丽伟, 狄佳, 江淑芳, 等. 对医护人员在新冠感染疫情期间的认知态度和行为调查研究. 中国医疗管理科学, 2021, 11(1): 66-71.
12. Jabarpour M, Dehghan M, Afsharipour G, et al. The impact of COVID-19 outbreak on nosocomial infection rate: a case of Iran. Can J Infect Dis Med Microbiol, 2021, 2021: 6650920.
13. 王瑶, 王征, 张双龙, 等. 新型冠状病毒肺炎疫情下非定点医院重症监护病房的医院感染管理. 中国中西医结合急救杂志, 2020, 27(5): 562-565.
14. 王国兴, 李银芝, 李敏, 等. 新型冠状病毒肺炎疫情防控期间高压氧病房医院感染现状: 单中心报告. 中华航海医学与高气压医学杂志, 2021, 28(5): 656-658.
15. 付雪松, 曾惠敏, 张霁, 等. 新冠疫情期间肿瘤医院住院患者医院感染及相关因素分析. 医院管理论坛, 2021, 38(2): 60-62,36.
16. Maes M, Higginson E, Pereira-Dias J, et al. Ventilator-associated pneumonia in critically ill patients with COVID-19. Crit Care, 2021, 25(1): 25.
17. Basile C, Combe C, Pizzarelli F, et al. Recommendations for the prevention, mitigation and containment of the emerging SARS-CoV-2 (COVID-19) pandemic in haemodialysis centres. Nephrol Dial Transplant, 2020, 35(5): 737-741.
18. 国家肾病学专业医疗质量管理与控制中心, 国家慢性肾病临床医学研究中心, 肾脏疾病国家重点实验室. 新型冠状病毒肺炎疫情防控期间血液透析质控专家共识. 中华医学杂志, 2022, 102(26): 1982-1986.
19. Knudsen AR, Kolle S, Hansen MB, et al. Effectiveness of an electronic hand hygiene monitoring system in increasing compliance and reducing healthcare-associated infections. J Hosp Infect, 2021, 115: 71-74.
20. 安敏, 曹虎男, 戴小梅, 等. 急性肾损伤患者连续性肾脏替代治疗两种连接引血方式对血流动力学影响的研究. 中华急危重症护理杂志, 2023, 4(10): 869-874.
21. Shimohata T, Mawatari K, Uebanso T, et al. Bacterial contamination of hemodialysis devices in hospital dialysis wards. J Med Invest, 2019, 66(1/2): 148-152.
22. Novosad SA, Lake J, Nguyen D, et al. Multicenter outbreak of gram-negative bloodstream infections in hemodialysis patients. Am J Kidney Dis, 2019, 74(5): 610-619.
23. Amarsy R, Fournier S, Trystram D, et al. Decrease of hospital- and community-acquired bloodstream infections due to Streptococcus pneumoniae and Streptococcus pyogenes during the first year of the COVID-19 pandemic: a time-series analysis in Paris region. Am J Infect Control, 2023, 51(4): 475-477.
24. Farrington CA, Allon M. Management of the hemodialysis patient with catheter-related bloodstream infection. Clin J Am Soc Nephrol, 2019, 14(4): 611-613.
25. Kotwal S, Cass A, Coggan S, et al. Multifaceted intervention to reduce haemodialysis catheter related bloodstream infections: REDUCCTION stepped wedge, cluster randomised trial. BMJ, 2022, 377: e069634.
26. Mohamed H, Ali A, Browne LD, et al. Determinants and outcomes of access-related blood-stream infections among irish haemodialysis patients, a cohort study. BMC Nephrol, 2019, 20(1): 68.
27. Brown RS, Brickel K, Davis RB. Two-Year Observational Study of Bloodstream Infection Rates in Hemodialysis Facility Patients with and without Catheters. Clin J Am Soc Nephrol, 2018, 13(9): 1381-1388.
28. Hasanoglu I, Guner R, Sahin S, et al. Surveillance of hemodialysis related infections: a prospective multicenter study. Sci Rep, 2020, 12(1): 22240.
29. Demirci R, Sahtiyancı B, Bakan A, et al. The predictors of catheter-related bloodstream infections in patients undergoing hemodialysis: a single center experience. J Vasc Access, 2023, 24(1): 76-81.

West China Medical Journal

Comparison of vascular access infection incidence of hemodialysis patients during epidemic and non-epidemic period of COVID-19

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