Reduced CVC-related infection rate during the CO VID -19 pandemic

ABSTRACT

Background: In hemodialysis (HD) patients, central venous catheter (CVC) related bloodstream infections are a major cause of morbidity and mortality. Hygienic precautions are a key aspect of dialysis care for infection prevention, but they are not sufficient to avoid the occurrence of CVC related infections. During the COVID-19 pandemic, hygienic precautions for preventing viral transmission have been reinforced. We evaluated their effects on CVC-related infection rates. Materials and Methods: An observational mono-centric retrospective study was conducted in our hemodialysis unit. In the last year, we treated 137 chronic hemodialysis patients, 54 of whom (39%) using either a tunneled-CVC or a not-tunneled-CVC. In the CVC cohort, we compared data on catheter-related infection rates during the COVID-19 pandemic in Italy (February to December 2020) with data from the whole of 2019. Results: In 2019, we recorded a catheter-related bloodstream infection (CRBSI) rate of 0.94 (95% CI 0.52-1.56)/1000 days and a tunnel and exitsite infection rate of 1.3 (95% CI 0.79-2.01)/1000 days. Infection rates drastically decreased during the COVID-19 pandemic, with just three catheter- related bloodstream infections being recorded. Catheter-related bloodstream infection rates showed a significant reduction to 0.26 (95% CI 0.06-0.72)/1000 days (p = 0.03) and a non-significant reduction in tunnel and exit-site infections to 0.8 (95% CI 0.45-1.58)/1000 days. Conclusions: The observed 72% reduction in catheter-related bloodstream infections compared to the whole of 2019 (IRR 0.28 (95% CI 0.06-0.92) suggests that a stricter implementation of hygienic precautions in the dialysis setting can markedly improve the problem of CVCrelated infections.