Reported practices and difficulties for preventing emerging highly resistant bacteria in hemodialysis: the PHYDEL survey

Aim: Chronic hemodialysis patients are at risk of Vancomycin-resistant Enterocci (VRE) and carbapenemase-producing Enterobacteriaceae (CPE) carriage. France has released guidelines to prevent the spread of VRE-CPE carriage in hospitals. However, the hemodialysis setting is confronted with specific problems that are not always addressed by guidelines. Infection control practices regarding VRE-CPE transmission in the hemodialysis setting have not been described in the literature. The aim of our survey was to assess declared practices regarding VRE-CPE identification and management in French hemodialysis units (HDU). Methods: A cross-sectional survey was conducted in a random sample of 200 French HDU (excluding peritoneal dialysis and exclusive pediatric hemodialysis units) regarding their declared organization for identifying VRE-CPE carriers, the type and duration of precautions implemented, and reported difficulties. Data were collected via an e-mail questionnaire, and completed by a short telephone interview with an infection control nurse. Results: 103 HDU agreed to participate. A minority of HDU had implemented a system to identify patients requiring screening or were able to keep track of VRE-CPE carriers and contacts via a computerized system. When managing VRE-CPE carriers, less than one-third of HDU employed caregivers, and strategies to discontinue precautions varied widely between HDU. HDU staff complained mainly about the lack of national specific guidelines for VRE-CPE in the hemodialysis setting, insufficient information regarding patients’ VRE-CPE status, and difficulties in convincing patients to accept screening. Conclusion: This survey highlights heterogeneous practices and routine difficulties in VPE-CPE patients’ management which would probably benefit from guidelines tailored to the hemodialysis setting.