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Kidney Int Rep. 2016 Nov 8;2(2):228-238. doi: 10.1016/j.ekir.2016.11.001. eCollection 2017 Mar.

Hemodialysis Infection Prevention Protocols Ontario-Shower Technique (HIPPO-ST): A Pilot Randomized Trial.

Author information

1
University Health Network-Toronto General Hospital, Toronto, Ontario, Canada.
2
McMaster University, Hamilton, Ontario, Canada.
3
London Health Sciences Centre, London, Ontario, Canada.
4
Mackenzie Health Hospital, Vaughan, Ontario, Canada.
5
The Scarborough Hospital, Scarborough, Ontario, Canada.
6
Credit Valley Hospital, Mississauga, Ontario, Canada.

Abstract

Introduction:

We developed the Hemodialysis Infection Prevention Protocols Ontario-Shower Technique (HIPPO-ST) to permit hemodialysis (HD) patients with central venous catheters (catheters) to shower without additional infection risk. Our primary objective was to determine the feasibility of conducting a parallel randomized controlled trial (RCT) to evaluate the impact of HIPPO-ST on catheter-related bacteremia (CRB) in adult HD patients.

Methods:

Adult HD patients using catheters were recruited from 11 HD units. Patients were randomized to receive HIPPO-ST or standard care and were followed up for 6 months. Only CRB-outcome assessors were blinded. For the study to be considered feasible, 4 of 5 feasibility outcomes, each with its own statistical threshold for success, must have been achieved.

Results:

A total of 68 patients were randomized (33 HIPPO-ST and 35 control) and were followed up to 6 months. Of 5 measures of feasibility, 4 were achieved: (1) accurate CRB rate documented (threshold: κ level >0.80); (2) 97.8% (279/285) of satellite HD patients with catheters were screened (threshold: >95%); (3) 88% (23/26) in the HIPPO-ST arm were successfully educated by 6 months (threshold: >80%); and (4) 0% (0/29) patients in the control arm were "contaminated," that is, using HIPPO-ST (threshold: <5%). However, only 44.2% (72/163) of eligible patients consented to participate (threshold: >80%). The rate of CRB was similarly low in HIPPO-ST and control groups (0.68 vs. 0.88/1000 catheter days).

Discussion:

This HIPPO-ST pilot study demonstrated the feasibility of the larger HIPPO-ST study, especially given the high levels of education success with the HIPPO-ST arm and the low levels of contamination in the control arm.

KEYWORDS:

catheter; hemodialysis; pilot study; randomized controlled trial; vascular access

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