Authors: (including presenting author): :
Chan TPA [1], Sin CSR [1], Lau SP [1], Cheung CW [1], Luk WC [1]
Affiliation: :
Renal Unit, Department of Medicine, North District Hospital.
Keyword 1: :
Catheter related infections
Keyword 2: :
Haemodialysis
Keyword 3: :
Chronic kidney disease
Introduction: :
Catheter-related bloodstream infections (CRBSI) and exit-site infections (ESI) remain a significant source of morbidity in haemodialysis. An effective catheter surveillance programme remains the key to success in lowering infections and other catheter-related complications.
Objectives: :
To address this issue, our regional hospital’s haemodialysis centre undertook a structured, evidence-based continuous quality improvement (CQI) initiative to systematically reduce the incidence of CRBSI.
Methodology: :
From February to October 2025, we implemented a phased, evidence-based intervention bundle with monthly process and outcome monitoring to reduce CRBSI/ESI in haemodialysis, in line with international guidelines and recommendations. Phase 1 (Feb 2025) established formal dialysis event surveillance, integrated case-based reviews into renal operations meetings, and introduced routine gentamicin catheter locks. Phase 2 (May 2025) added Chlorhexidine Gluconate (CHG)- impregnated dressings for all tunnelled catheters and optimised procedures by favouring right-sided Permcath insertions in an ultrasound-guided room to expedite conversion from non-tunnelled lines. Phase 3 (Jun 2025) developed an Infection Control Team (ICT) insertion checklist and invited external ICT audits of aseptic technique. Phase 4 (Oct 2025) expanded CHG dressings to all non-tunnelled catheters and limited non-tunnelled catheter exchanges to a single attempt to reduce aseptic breaches. Each phase followed Plan-Do-Study-Act (PDSA) cycles.
Result & Outcome: :
Before implementing the measures, we recorded two CRBSI episodes in January 2025 (one acute catheter–related and one PermCath-related). Following implementation, from February through December 2025, we documented three CRBSI events: one PermCath-related episode in April, one acute catheter–related episode in September, and one acute catheter–related episode in October. These findings indicate a reduction in CRBSI following the intervention. Our phased CQI program—integrating surveillance, evidence-based practices, and multidisciplinary teamwork—offers a robust framework for markedly reducing CRBSI in haemodialysis patients. Sustaining improvements will require ongoing audit cycles, monthly surveillance, and continuous staff training. Upcoming PDSA cycles could include implementing patient education on exit-site care and evaluating how prolonged gentamicin lock use influences antimicrobial resistance patterns.
