Peritoneal dialysis (PD) peritonitis - To reduce the rate of PD peritonitis to less than 0.5 infections per patient treatment year in 6 months

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Background

The project was undertaken in the local renal department. The prevalent PD population of approximately 50 is looked after by a team of 3 Specialist Nurses and 5 Consultants. Since 2015 the rate of PD peritonitis has risen. The International Society of Peritoneal Dialysis (ISPD) updated their guidelines in 2016 and the acceptable infection rate was dropped from 0.67 to 0.5 infections per patient treatment year. PD peritonitis is defined by the presence of 2 of the following; 1) Abdominal pain or cloudy PD effluent fluid, 2) white cell count >100 in PD effluent fluid or 3) Positive effluent culture. The PD catheter exit site (ES) sits in either iliac fossa. The catheter is tunnelled under the skin and enters the peritoneum just below the umbilicus. Exit site infection (ESI) is defined as erythema or purulent discharge at ES with a positive swab culture.

Aim

To reduce the rate of PD peritonitis to less than 0.5 infections per patient treatment year in 6 months. Also looked at the rate of ESI, link between ESI and PD peritonitis and number of PD catheters removed because of infection.

Method

Instructions on how to clean patient shower heads amended, PD education programme revised and written information distributed to patients to explain procedure if water supply interrupted.

Results

Target of less than 0.5 infections per treatment year was achieved. There were 14 ESI in 2015 and 12 ESI in 2016. Half of all ESI were associated with PD peritonitis. 11 PD catheters were removed because of PD peritonitis or ESI.

Implications

Although the rate of infection has fallen we are not currently treating ESI and PD peritonitis infections as per the ISPD guidelines which may have implications on number of PD catheters removed because of infection. Local guidelines are currently being reviewed and updated.