Core Interventions for the Prevention of Peritoneal Dialysis-Related Infections

Abstract

For some patients, peritoneal dialysis (PD) has several advantages over center-based hemodialysis. PD-related infections such as peritonitis and PD catheter exit site and tunnel infections are a significant source of morbidity. Peritonitis leads to increased mortality, and it is the leading cause of transfer off PD. Infection prevention practices may vary widely across dialysis centers, resulting in significant differences in infection rates. To address these issues and improve patient outcomes, the American Society of Nephrology facilitated the development of core interventions aimed at reducing PD-related infections across US dialysis facilities. The core interventions focus on six key strategies: ( 1 ) regular surveillance and feedback on infection rates, ( 2 ) standardized staff training and competency assessments, ( 3 ) standardized patient and care partner/caregiver education, ( 4 ) routine infection prevention assessments, ( 5 ) antimicrobial prophylaxis for PD catheter exit sites, and ( 6 ) prophylactic antimicrobials for certain procedures and events. These strategies, on the basis of evidence and international guidelines, emphasize consistency in implementation and monitoring at the facility level. The workgroup followed an iterative process, incorporating expert review and feedback to inform and refine these interventions. Effective implementation requires coordinated efforts among dialysis teams, patients, and support networks, with ongoing evaluation through surveillance and quality improvement initiatives. Although the interventions are grounded in current evidence, additional research is necessary to refine practices and address emerging challenges. The goal is to reduce infection risks, improve the quality of life for patients on PD, and support national efforts to expand home dialysis use.

Keywords: dialysis; dialysis access; peritoneal dialysis.