Cumplimiento de protocolos de prevención de infecciones, para disminuir bacteriemias asociadas a catéter en hemodiálisis: revisión sistemática

Catheter-associated bacteremia in hemodialysis is one of the most frequent and serious complications in patients with chronic kidney disease. Its occurrence is directly related to the quality of nursing care, adherence to aseptic protocols, and proper handling of vascular access. Given its high morbidity and mortality, economic impact, and epidemiological variability between units, it is essential to analyze the available evidence on compliance with preventive protocols. A systematic review was conducted following the PRISMA guidelines, including observational, cross-sectional, and cohort studies published in the last ten years, in Spanish and English. Articles were searched for in PubMed, Scielo, Cochrane, and Dialnet, using Boolean operators related to hemodialysis, infections, and nursing care. Two reviewers independently screened the titles, abstracts, and full texts. Seven studies conducted between 2013 and 2022 were included. The reported incidence ranged from 0.25 to 3.7 episodes per 1,000 catheter days, with better results in units with standardized protocols and high adherence by nursing staff. Gram-positive bacteria, especially Staphylococcus aureus and coagulase-negative staphylococci, were the most common microorganisms. The use of non-tunneled catheters and prolonged catheterization time increased the risk of infection. In addition, complications included endocarditis, septic thrombosis, and the need for ICU admission. Evidence confirms that strict adherence to nursing protocols significantly reduces catheter-associated bacteremia. Strengthening surveillance, ongoing training, and standardization of safe practices is essential to improve patient safety and reduce clinical and economic impact.