Survey of hemodialysis patients’ knowledge of their infection risk and acceptability of an intranasal decolonization intervention

Abstract Objective: While infection is a leading cause of mortality among patients on hemodialysis, there are limited data on patients’ infection prevention knowledge and attitudes. We aimed to assess hemodialysis patients’ knowledge of their elevated infection risk, their willingness to actively prevent infections, and the acceptability of a long-term intranasal decolonization intervention. Design: We surveyed patients as part of a stepped wedge cluster randomized trial evaluating intranasal povidone-iodine (PVI) decolonization. Setting: Sixteen outpatient hemodialysis centers affiliated with 5 academic medical centers. Participants: Patients undergoing outpatient hemodialysis. Methods: Patients were asked to complete a pre-intervention survey (9 questions) and two intervention surveys (13 questions; only patients interested in PVI) at 1 month and 6 months after starting PVI. We used the chi-squared test to compare responses over time. Results: 469 (∼25%) participants completed at least one survey. Most (55%) participants underestimated their infection risk compared with an average person in the United States. The percentage of participants willing to expend “a lot of effort” to prevent an infection decreased from 79% (pre-intervention) to 63% (final survey) ( p < 0.01). Among the 102 participants using PVI at 6 months, 87% said PVI felt neutral or pleasant and 75% used PVI for the past 3 dialysis sessions. Only 9.4% reported side effects. Conclusions: Patients on hemodialysis underestimate their infection risk. Most patients found intranasal PVI to be acceptable. Future research should aim to improve patient education on their infection risk and remove barriers to adherence with infection prevention interventions. Clinical trial information: NCT04210505, https://clinicaltrials.gov/