Authors (including presenting author) :
Mok WS(1), Lee KH (1), Lam WS(1), Wong KYS (1), Yeung CP(1), Tsang WY(1), Wong SHS(1)
Affiliation :
(1) Renal Unit, Department of Medicine & Geriatrics, United Christian Hospital, Hong Kong SAR
Keyword 1: :
Peritoneal Dialysis fluid
Keyword 2: :
Culture Standardization
Keyword 3: :
Quality Improvement
Introduction :
Microorganism cultivation is essential for diagnosing peritoneal dialysis peritonitis and guiding effective treatment. Culture-negative peritonitis often results from technical issues such as sampling errors, inadequate dwell time, and delays in transport. These factors decrease the likelihood of recovering bacteria in culture. At United Christian Hospital (UCH), the culture-negative rate is already below the benchmark of 15% for all peritonitis episodes, as recommended by the ISPD 2022 guidelines. However, non-standardized procedures in collecting and handling peritoneal dialysis fluid (PDF) samples may still contribute to culture-negative episodes and delay diagnosis and appropriate antibiotic therapy. To ensure patient safety and quality of care, standardization through structured nursing guidelines should be developed to strengthen consistency, maintain low culture-negative rates, reduce manual errors, and meet international standards.
Objectives :
(1) To develop and implement a standardized nursing guideline for collecting and handling peritoneal dialysis effluent samples. (2) To evaluate the patient outcomes and nurses’ compliance.
Methodology :
The guideline was developed based on comprehensive literature review, aligned with international standards, and covered procedures from the PDF culture collection to laboratory processing. It was launched in November 2024. To enhance understanding and ensure proper adherence, an instructional video demonstrating the entire collection process was created and shared with staff. Training sessions were conducted for all relevant staff. After implementation, data on culture-negative rate retrieved from the Organ Registry and Transplant System for one year before and after the guideline implementation were compared. Additionally, an audit was conducted to assess nurses' compliance during PDF culture sampling.
Result & Outcome :
The culture-negative rate was 11.8% before and decreased to 9.3% after implementing the guideline, both below the ISPD benchmark of 15% .Nursing audit results demonstrated 100% compliance with the standardized sampling procedure, covering all critical steps, including patient identification, aseptic technique, effluent mixing, double alcohol swabbing, safe aspiration and sealing, sharps disposal, and accurate specimen dispatch. In conclusion, the implementation of a standardized guideline successfully reduced the culture-negative rate. Strong adherence by nursing staff ensured accurate and reliable results, contributing to improved patient outcomes. Importantly, early adjustment of antibiotic treatment according to culture results was facilitated, reducing the risk of peritonitis-related complications such as Tenckhoff catheter loss and mortality. These outcomes support the sustainability of the guideline and highlight its role in strengthening long-term standards of care. Regular audits are recommended to sustain these achievements.
