Peritonitis per patient and year: a basic index.

This article is also accessible online at: http://BioMedNet.com/karger Dear Sir, For the past 15 years, the appropriate treatment of end stage renal failure has included both continuous ambulatory peritoneal dialysis (CAPD) and haemodialysis. In some circumstances CAPD has been indicated as a more adequate option. However, the main handicap for CAPD patients is peritoneal infection [1], ranking as the main cause of hospital admission and transfer to haemodialysis [2]. Peritonitis represents the third highest cause of death in CAPD patients [3]. It also produces a 15–19% deterioration of peritoneal membrane function. Fighting against peritoneal infection has been a constant challenge for CAPD teams from the very beginning. It has included the utilization of specially designed connection devices (connectors), integrated systems, routine use of antiseptics, flush before fill procedures and other preventive measures. The number of peritonitis episodes per patient per year (P/p/y) is a valid and simple measurement to judge the quality of care provided by CAPD units. It has been surveyed for many years at most CAPD units. In 1992, our team initiated a new program with two points of emphasis. (1) More involvement of the patients. The inclusion of CAPD patients was strictly voluntary. Hygiene and dietetic habits were reinforced and accepted by the patients. Nutritional status was carefully maintained, as it plays a key role in the incidence of infections [4–6]. Training was methodical and progressive including video and audio recordings [7] and use of other learning material. Patient techniques were reevaluated every 4–6 months. The home conditions included a washing place (or toilet) integrated in (or close to) the exchange room. (2) New strategies adapted by the staff. This included the maintenance of the same medical and nursing team, the homogenization of criteria and protocols, the rapid detection of intercurrent diseases and a close review of the adequacy of dialysis