Preventing infection in peritoneal dialysis patients

The Peritoneal Dialysis (PD) implementation project commenced in August 2010 when a call for Expressions of Interest was sent out to ANZSN members. The first steering committee meeting was held in December 2010 to decide which units to include in the project. The first face to face meeting with the 8 participating units (7 from Australia, 1 from New Zealand) was held in Sydney in April 2011. The PD project is focussed on the implementation of KHA-CARI and ISPD guidelines regarding the prophylactic use of antibiotics and antifungals in PD patients. Essentially, these are: use of prophylactic antibiotics at insertion of PD catheter; use of prophylactic antibiotics at the exit site or nasally; and use of antifungal prophylaxis whenever a PD patient is given a course of antibiotics.

The first phase of the project involved the collection of baseline data for each unit, including PD-related infection rates, and unit practices, policies and protocols around the topic. Data collection ran for 6 months and finished on 30 June 2012. A key part of this phase was to identify barriers and enablers to the uptake of the guideline recommendations. The units and the project’s steering committee both contributed to this process.

The second phase is the implementation phase when tools are developed for the units to use which are intended to help overcome some of the barriers encountered in day to day practice. These tools have been developed and are currently being piloted at one of the units. The implementation phase will run for 12 months and will commence approx. October 2013 and finish at the end of June 2014. The units will have a face to face meeting with the steering committee after 6 and 12 months so that they can report back on any issues they have encountered with using the tools, discuss changes made/not made at their unit during this active phase and suggest improvements that could be used in future implementation programs. A post-intervention phase will run for another 6 months after June 2014 in which units will be asked to continue to collect and forward their infection data to the KHA-CARI project coordinator and to continue to use the implementation tools. The data from this period will be compared with the data obtained during the 12-month implementation phase.