Daily self-care practices influence exit-site condition in patients having peritoneal dialysis: A multicenter cross-sectional survey

Abstract

Aims: To investigate practice patterns in exit-site care and identify the risk factors for exit-site infection.

Design: A quantitative cross-sectional design.

Methods: Data were collected in 12 peritoneal dialysis (PD) centres in 2018. Daily exit-site care practice patterns and exit-site status of patients receiving PD were assessed through interviews and questionnaires.

Results/findings: Most of the 1,204 patients adhered with the protocols about main aspects of exit-site care, such as cleansing agents selection, frequency of cleansing, catheter fixation, and following the catheter protective measures. However, their adherence levels on hand hygiene, mask wearing, observing exit site, examining secretion, and communicating with PD staff were rather low. Eighty-four patients' exit sites were evaluated as problematic exit site (PES). And 186 patients had catheter-related infection (CRI) history. After multivariable logistic regression analysis, diabetes (OR = 1.631), traction bleeding history (OR = 2.697), antibiotic agents use (OR = 2.460), compliance on mask wearing (OR = 0.794), and observing exit site (OR = 0.806) were influencing factors of CRI history. Traction bleeding history (OR = 2.436), CRI history (OR = 10.280), and effective communication (OR = 0.808) with PD staff were influencing factors for PES.

Conclusions: The adherence levels on different aspects of exit-site care were varied in patients having PD. Their self-care behaviours did correlate with the exit-site status.

Impact: The adherence level of patients' exit-site care practice needs attention of medical staff. Further studies about the optimal procedure in exit-site care were warranted.

Keywords: adherence; catheter-related infection; exit-site care; exit-site infection; nursing; peritoneal dialysis; retraining; self-care.