How is an exit site infection prevented?
Prevention of exit site infections (and peritonitis, described later) starts with proper placement of the PD catheter. The exit site of the catheter should be in a location that can be clearly seen by the patient, downward or laterally facing to preclude funneling of dirt or cellular debris into the catheter exit site, and not buried in a panniculus or abdominal skinfold. Prophylactic antibiotics given prior to PD catheter placement have value in preventing subsequent peritonitis. Avoidance of anchoring sutures at the PD exit site and allowing the PD catheter to remain covered, clean, dry, and undisturbed until well healed are additional key factors in preventing an infectious nidus from being seeded about the catheter exit site or tunnel. Consistent, steadfast training of the patient and staff regarding sterile technique, observation of meticulous handwashing, and daily exit site care is then required. Application of either mupirocin or gentamycin cream to the exit site prevents infections.