Using Chlorhexidine-Coated Dialysis Catheter Caps to Reduce Central Venous Dialysis Catheter Infection Rates: A Quality Improvement Project

Background Many patients with end-stage kidney disease begin dialysis therapy with central venous dialysis catheters, significantly increasing the risk of dialysis catheter–related bloodstream infection. Bloodstream infections are among the most severe harm events affecting patients receiving dialysis. Local Problem In 2023, the dialysis catheter–related central line [catheter]–associated bloodstream infection (CLABSI) rate at an acute care medical center in southern California was thrice the national benchmark. This quality improvement project aimed to decrease this rate by adding chlorhexidine-coated dialysis catheter caps to standard care. Methods Using the Knowledge to Action model, the medical center made a dialysis catheter–related CLABSI reduction practice change. Preimplementation and postimplementation monthly aggregate data were collected for dialysis catheter–related CLABSIs, central venous dialysis catheter days, and dialysis catheter–related infection rates. One-on-one dialysis staff simulation training and process compliance audits ensured intervention fidelity. The intervention was replacement of nonchlorhexidine dialysis catheter caps with chlorhexidine-coated dialysis catheter caps for patients with central venous dialysis catheters. Results An 8-week preimplementation period included 119 patients, 561 dialysis therapies, 934 central dialysis catheter days, and 2 dialysis catheter–related CLABSIs (2.14 infections per 1000 catheter days). An 8-week postimplementation period included 128 patients, 583 dialysis therapies, 897 central dialysis catheter days, and 0 dialysis catheter–related CLABSIs; no dialysis catheter–related CLABSIs occurred during postimplementation sustainability assessment (24 weeks total). Conclusions Use of chlorhexidine-coated dialysis catheter caps led to clinically significant results among patients receiving dialysis with central catheters at an acute care medical center.