Introduction:
COST!! Dialysis significantly impacts healthcare budgets, especially hemodialysis (HD), which is costlier than peritoneal dialysis (PD) yet remains the dominant method in Malaysia. A five-year study on the impact of HD and PD on government funding showed that increasing the proportion of patients on PD could reduce dialysis-associated costs in Malaysia. This suggests a policy shift toward PD as the first-line treatment could benefit the Malaysian government, an upper-middle-income developing country in Southeast Asia. However, challenges remain, particularly in preventing PD-related infections. There is a need for better prevention, diagnostics, and treatment to improve infection outcomes. For example, PD-associated Non-Tuberculous Mycobacterium (NTM) infection, though rare, is linked with high morbidity, prolonged antimicrobial use, catheter loss, and treatment failure, highlighting the need for improved infection control measures.
Methods:
This study aims to determine the potential effect of the application of 2.0% chlorhexidine dressing at the catheter exit site in preventing Exit Site Infection (ESI) compared to 10.0% povidone solution. This was a single center observational study conducted on PD patients at Hospital Sultanah Aminah, Johor Bahru. Traditionally, povidone dressing has been used, however since May 2023, we have changed to chlorhexidine 2.0%. A Comparison was made between patients who developed ESI from April 2022-April 2023 (Povidone group) and from May 2023-May 2024 (Chlorhexidine group).
Results:
The mean age of the participants was 56.4 (SD=17.62) years old. The majority was female (53.7%,n=43), while Malays constituted about (60%,n = 48) . Among them, CAPD patients were 85%, n=68, while APD constitutes 15% ,n = 12 with a PD vintage of 12.5 months and assisted was 68.8%, n= 55.The incidence of ESI were 0.19 episode per patient years in the povidone group,whereas 0.12 episode per patient years in the chlorhexidine group with a P value of 0.06 . There was about 0.02 episode per patient years of gram negative in chlorhexidine group as compared to povidone group with 0.08 episode per patient years ,significant P value of <0.001. The NTM rate was 0.03 episode per patient years in the povidone group and 0.01 episode per patient years in chlorhexidine group with P value of 0.268.
Conclusions:
Our study shows chlorhexidine dressings did not increase the incidence of exit site infection and out perform povidone in reducing the rate of gram-negative bacteria in PD patients. Chlorhexidine also has significant economic benefits, costing RM 1.50 per bottle compared to RM 3.10 for povidone. Routine care requires around 315 bottles of chlorhexidine weekly, costing RM 1,890 annually, while povidone needs 260 bottles, costing RM 3,224 yearly. This demonstrates chlorhexidine's cost-effectiveness, especially in resource-limited setting.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.