422 Fig 24.5 (continued) A M Onder and M J G Somers 24 Infectious Complications of Hemodialysis in Children Fig 24.5 (continued) 423 424 Fig 24.5 (continued) A M Onder and M J G Somers 24 Infectious Complications of Hemodialysis in Children 425 Fig 24.5 (continued) to assess during such infection-centered rounds, with separate auditing tools for items that should be surveyed frequently compared to those requiring only intermittent or special consideration Conclusion This risk of infection for the child on hemodialysis is most influenced by the child’s dialysis access Although children with permanent vascular access in the form of AVF or AVG are much less likely to have dialysis-related infections than children who receive HD via catheter, many children on HD rely on catheters The ongoing development and adoption of practices specific to HD catheter use and care should help minimize infection risk, with special focus on improving rates of CRBSI (Fig. 24.8) Key Take-Home Messages for This Chapter Include Reports from both single pediatric centers and a multicenter collaborative of pediatric dialysis units show that implementation of guidelines that stress meticulous hand hygiene, chronic care of the catheter exit site, and aseptic connections to the HD catheter hubs decreases CRBSI in children Antisepsis of skin near the exit site and of the HD catheter hubs should use agents with demonstrated efficacy in the dialysis setting, notably >0.5% chlorhexidine with alcohol, 70% alcohol, or 10% povidone-iodine Triple antibiotic ointment or a chlorhexidine patch should be placed at the exit site and then covered with a transparent dressing or gauze; the exit site should be visualized with each dialysis treatment, and exit site care and a new dressing placed at least weekly Antibiotic locks are an effective prophylactic strategy and have also been shown to augment cure rates when used with systemic antibiotics for treatment of CRBSI With suspected CRBSI, blood cultures should be obtained from the catheter hubs/HD circuit prior to antibiotic treatment; broad-spectrum antibiotics such as vancomycin and ceftazidime are commonly used empirically while awaiting culture results CRBSI with microorganisms that are difficult to clear from vascular catheters such as Pseudomonas, Staphylococcus aureus, or fungus generally mandates catheter removal Persistently positive blood cultures or recurrent symptoms during antibiotic treatment also require HD catheter removal; wire-guided exchange can be safely utilized for most patients Antibiotics should be provided with CRBSI for at least 2–3 weeks after negative blood cultures are first obtained; complicated infections may require longer therapy Exit site and tunnel infections generally respond rapidly to initiation of antibiotics and usually are not associated with CRBSI AVF and AVG infections are rare; AVG infections are more likely to be complicated or require surgical intervention 426 Fig 24.6 Infection prevention intermittent frequency rounding tool Various factors relating to the environment of care that play a more limited role in infection risk, but nonetheless should be assessed at intervals This rounding tool covers environmental parameters that should be A M Onder and M J G Somers assessed with intermittent frequency (Rounding tool shared with permission: Standardizing Care to Improve Outcomes in Pediatric End Stage Renal Disease (SCOPE) Collaborative, Children’s Hospital Association) 24 Infectious Complications of Hemodialysis in Children Fig 24.6 (continued) 427 ... surveyed frequently compared to those requiring only intermittent or special consideration Conclusion This risk of infection for the child on hemodialysis is most influenced by the child’s dialysis... infection risk, with special focus on improving rates of CRBSI (Fig. 24.8) Key Take-Home Messages for This Chapter Include Reports from both single pediatric centers and a multicenter collaborative... that play a more limited role in infection risk, but nonetheless should be assessed at intervals This rounding tool covers environmental parameters that should be A M Onder and M J G Somers assessed