K.LIM1, S.WANG1, C.MUTHAYAN1, R.ROSLAN1, Y.P.SEE1
Tan Tock Seng Hospital1
Peritoneal dialysis (PD) related infections remain the Achille’s heel of PD. Hand-hygiene is crucial but few studies discussed on choice of handwash and infection.
An audit of handwash and PD infection was therefore performed.
Retrospective cohort study and phone interview of prevalent PD patients at Tan Tock Seng Hospital between 1/1/2021 – 30/4/2021 were conducted. Baseline characteristics and primary outcomes of history of exit site infection (ESI), peritonitis, ESI and peritonitis rates (expressed as episodes/patient-year) were obtained. Chi-square test, independent t-test and Mann-U Whitney test were performed to evaluate difference in infection amongst chlorhexidine-based (CH) and non-chlorhexidine (NCH) based used.
166 patients were audited. 71% (n=118) used CH, 29% (n=48) used NCH. Final analysis of 166 patients found similar baseline characteristics, median age [66 (55-76) v 65 (52-73) years, p=0.52], proportion of diabetic (65% v 73%, p=0.34) and median PD vintage [2 (1-4) v 2(1-3) years, p=0.53]; CH versus NCH retrospectively. History of ESI were similar in both groups, 34% (40/118) versus 27% (13/48), p=0.39 (CH and NCH respectively). ESI rates were not different, 0.25 ± 0.56 and 0.13 ± 0.31 episodes/patient year. However, NCH had less peritonitis, 8% (4/48) versus 27% (32/118), p=0.01. While missing statistical significance, there is lower rate of peritonitis amongst NCH, 0.05 ± 0.18 compared to 0.17 ± 0.36 peritonitis/patient-year (p=0.06).
Use of chlorhexidine handwash was not associated with lower incidence of PD infection and potentially increase peritonitis but potential recall bias and residual confounders are limitations of this audit and more studies are needed.