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Kosa SD, Gafni A, House AA, et al. Hemodialysis Infection Prevention Protocols Ontario-Shower Technique (HIPPO-ST): A Pilot Randomized Trial. Kidney Int Rep. 2016;2(2):228-238doi: 10.1016/j.ekir.2016.11.001.
Kosa, S. D., Gafni, A., House, A. A., Lawrence, J., Moist, L., Nathoo, B., Tam, P., Sarabia, A., Thabane, L., Wu, G., & Lok, C. E. (2017). Hemodialysis Infection Prevention Protocols Ontario-Shower Technique (HIPPO-ST): A Pilot Randomized Trial. Kidney international reports, 2(2), 228-238. https://doi.org/10.1016/j.ekir.2016.11.001
Kosa, S Daisy, et al. "Hemodialysis Infection Prevention Protocols Ontario-Shower Technique (HIPPO-ST): A Pilot Randomized Trial." Kidney international reports vol. 2,2 (2017): 228-238. doi: https://doi.org/10.1016/j.ekir.2016.11.001
Kosa SD, Gafni A, House AA, Lawrence J, Moist L, Nathoo B, Tam P, Sarabia A, Thabane L, Wu G, Lok CE. Hemodialysis Infection Prevention Protocols Ontario-Shower Technique (HIPPO-ST): A Pilot Randomized Trial. Kidney Int Rep. 2016 Nov 08;2(2):228-238. doi: 10.1016/j.ekir.2016.11.001. eCollection 2017 Mar. PMID: 29142959; PMCID: PMC5678668.
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Kidney Int Rep. 2016 Nov 08;2(2):228-238. doi: 10.1016/j.ekir.2016.11.001. eCollection 2017 Mar.

Hemodialysis Infection Prevention Protocols Ontario-Shower Technique (HIPPO-ST): A Pilot Randomized Trial.

Kidney international reports

S Daisy Kosa, Amiram Gafni, Andrew A House, JulieAnn Lawrence, Louise Moist, Bharat Nathoo, Paul Tam, Alicia Sarabia, Lehana Thabane, George Wu, Charmaine E Lok

Affiliations

  1. University Health Network-Toronto General Hospital, Toronto, Ontario, Canada.
  2. McMaster University, Hamilton, Ontario, Canada.
  3. London Health Sciences Centre, London, Ontario, Canada.
  4. Mackenzie Health Hospital, Vaughan, Ontario, Canada.
  5. The Scarborough Hospital, Scarborough, Ontario, Canada.
  6. Credit Valley Hospital, Mississauga, Ontario, Canada.

PMID: 29142959 PMCID: PMC5678668 DOI: 10.1016/j.ekir.2016.11.001

Abstract

INTRODUCTION: We developed the Hemodialysis Infection Prevention Protocols Ontario-Shower Technique (HIPPO-ST) to permit hemodialysis (HD) patients with central venous catheters (catheters) to shower without additional infection risk. Our primary objective was to determine the feasibility of conducting a parallel randomized controlled trial (RCT) to evaluate the impact of HIPPO-ST on catheter-related bacteremia (CRB) in adult HD patients.

METHODS: Adult HD patients using catheters were recruited from 11 HD units. Patients were randomized to receive HIPPO-ST or standard care and were followed up for 6 months. Only CRB-outcome assessors were blinded. For the study to be considered feasible, 4 of 5 feasibility outcomes, each with its own statistical threshold for success, must have been achieved.

RESULTS: A total of 68 patients were randomized (33 HIPPO-ST and 35 control) and were followed up to 6 months. Of 5 measures of feasibility, 4 were achieved: (1) accurate CRB rate documented (threshold: κ level >0.80); (2) 97.8% (279/285) of satellite HD patients with catheters were screened (threshold: >95%); (3) 88% (23/26) in the HIPPO-ST arm were successfully educated by 6 months (threshold: >80%); and (4) 0% (0/29) patients in the control arm were "contaminated," that is, using HIPPO-ST (threshold: <5%). However, only 44.2% (72/163) of eligible patients consented to participate (threshold: >80%). The rate of CRB was similarly low in HIPPO-ST and control groups (0.68 vs. 0.88/1000 catheter days).

DISCUSSION: This HIPPO-ST pilot study demonstrated the feasibility of the larger HIPPO-ST study, especially given the high levels of education success with the HIPPO-ST arm and the low levels of contamination in the control arm.

Keywords: catheter; hemodialysis; pilot study; randomized controlled trial; vascular access

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