Discussion

Our study shows that Amuchina is effective in the prevention of exit-site infection during the 14 months of the study, seventeen times more than pH neutral soap. With very similar groups, in age, and time on dialysis, when is compared the Amuchina group with the soap group, the OR: 17, shows the safety of using the chloroxidizer, which is statistically significant (p = 0.004). There are some items to be observed, such as all children took care of their own exit-sites. Somehow it is surprising that Pseudomonas was our dominant strain isolated, and in second place Staphylococcus, maybe because the use of mouth mask and also we can consider pH neutral soap as placebo. Anyhow, more studies, with larger population have to be done but results are hopeful for developing countries that cannot afford newer and expensive measures for preventing exit-site infection [5].

It is described that S. aureus is the bacteria to control, is a multifactor group that is seen in all devices that are used for treating patients. As is documented, a good and careful catheter installation, preventing antimicrobial contamination before, during and after the intervention, avoiding catheter traction, a good antiseptic can give excellent results, without getting resistant strains [8].

Finally, following the infectologist's advice for using antimicrobial drugs only when necessary.

Further studies have to be done, but we will always cope the malnourished patient, the chronic inflammation, the children, diabetic patients, etc., but the basic rules of medical devices have to be followed. Those are quality assurance, above all in developing countries, continuing education, and choice of the catheter insertion site, and hand hygiene with antiseptic techniques [3, 5, 9].

Maybe the future is in the modification of catheter material that would be antiadhesive to biofilms or at least colonization resistant [8]. Meanwhile, in our center we will continue to study the electrolytic chloroxidizer as part of many measures to avoid exit-site infections in larger population.

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