Efficacy of Using Chlorhexidine Impregnated Foam Dressing (BIOPATCH) among Patients on Haemodialysis with Tunneled Haemodialysis Catheters

Background: Tunneled haemodialysis catheter related blood stream infections (CRBSI) lead to increased morbidity and mortality, including hospital admissions and antibiotic resistance with increased health care costs. Therefore, proper tunneled haemodialysis line exit site care and dressings are a vital step in preventing the above mentioned consequences. With this background an audit was performed to confirm the efficacy of (BIOPATCH) in reducing the exit site infections in haemodialysis patients in single dialysis unit. Methods: All patients with Tunneled haemodialysis catheters in Queens Hospital Haemodialysis unit, Romford, UK were included in the audit. Patients were verbally consented for dressing change and exit sites swabs. Audit and re-audit cycles spanned over a total period of 15 months. All exit site routine swab positivity data was collected over this period. From January 1, 2023 to May 30, 2023 sterile transparent dressing without BIOPATCH was used. From May 31, 2023 to October 30, 2023 all the patients were offered chlorhexidine impregnated foam dressing (BIOPATCH) as a standard practice. The first audit cycle was completed and haemodialysis staff was informed about the findings of the audit with emphasis on adherence to strict aseptic protocols and completion of IPC chart (Infection Prevention and Control Chart) for each haemodialysis session. Thereafter a re-audit was carried out from November 1, 2023 to March 30, 2024. Results: Total number of patients were 52. 13 patients had positive exit site swabs from January to May 2023 where only the transparent dressing was used without BIOPATCH. From May to October 2023 when BIOPATCH was initially used, 20 exit site positive swabs were found. During reaudit from November 1, 2023 to March 30, 2024, BIOPATCH use with increased compliance with aseptic protocols resulted in reduction of positive swabs to 9. Conclusion: BIOPATCH dressing with adherence to aseptic practice led to the lowest number of patients (9) with tunneled line exit site positive swabs. However, using BIOPATCH without meticulous adherence to infection control protocol did not improve exit site swab positivity rate. The use of chlorhexidine impregnated foam dressing (BIOPATCH) along with the strict aseptic protocols is superior in reducing the exit site swab positivity rates. Funding: NIDDK Support