Infection Control Practices for Vascular Access Management in Hemodialysis: Results From a Nationwide Survey of Japanese National University Hospitals

INTRODUCTION: Bloodstream infections due to repeated vascular access (VA) puncture and circuit connections remain major concerns in hemodialysis. Therefore, we examined current practices for glove, disinfectant, and personal protective equipment (PPE) use according to VA type in national university hospitals in Japan. METHODS: Two questionnaire surveys were conducted between 2019 and 2022, with responses obtained from all 42 hospitals. RESULTS: All facilities used disposable gloves for cannulation and VA connection. Nonsterile gloves were more frequently used than sterile gloves for arteriovenous fistula (AVF), arteriovenous graft (AVG), subcutaneously fixed superficial artery, noncuffed catheters, and cuffed catheters. In 2019, nonsterile gloves were reported in 67% of facilities for AVF, 60% for AVG, 71% for subcutaneously fixed superficial arteries, 74% for noncuffed catheters, and 73% for cuffed catheters. In 2022, rates were 81%, 60%, 67%, 64%, and 67%, respectively. Disinfectant selection differed by VA type. In 2019, chlorhexidine gluconate (CHG) was most commonly used for AVF, povidone-iodine (PI) for AVG and subcutaneously fixed superficial arteries, and alcohol for both noncuffed and cuffed catheters. In 2022, CHG-alcohol predominated for AVF, while PI remained a common disinfectant for AVG and subcutaneously fixed superficial arteries. PPE use increased from the first to the second survey. CONCLUSIONS: Infection control practices during VA cannulation and connection varied even among national university hospitals. Further studies evaluating associations with infection outcomes are needed.