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A Prospective Study of Infections in Hemodialysis Patients: Patient Hygiene and Other Risk Factors for Infection

  • Lisa G. Kaplowitz (a1), Jane A. Cornstock (a1), Douglas M. Landwehr (a1), Harry P. Dalton (a1) and C. Glen Mayhall (a1)...


We performed a prospective randomized study on 71 patients on chronic outpatient hemodialysis to determine whether a sterile technique was better than a clean technique for preparation of the skin over the vascular access site prior to cannulation. In addition, we wanted to determine overall and site-specific infection rates, microbial etiologies of infection, and risk factors for infection. The overall infection rate was 4.7 infections per 100 dialysis months; the vascular access-site infection rate was 1.3 infections per 100 dialysis months; and the rate for bacteremia was 0.7 cases per 100 dialysis months. Staphylococcus aureus was the most common pathogen, but infections were equally divided between gram-positive cocci and gram-negative bacilli. Advanced age (P = 0.02), a low Karnofsky activity score (P = 0.05), poor hygiene (P = 0.0004) and number of hospitalizations (P = 0.0002) were risk factors for infections in general while only poor hygiene (P = 0.002) was a risk factor for vascular access-site infection. Sterile preparation of the skin over the vascular access site was no more effective at preventing infection than was clean technique (P = 0.80). Maintenance of good personal hygiene may be one of the most important measures for prevention of infections in hemodialysis patients


Corresponding author

Hospital Epidemiology Unit, Division of Infectious Diseases, Medical College of Virginia, Box 19, MCV Station, Richmond, VA 23298-0019


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