Patient and Healthcare Provider Perspectives on Showering for Patients With Hemodialysis Central Venous Catheters: A Survey Study

Jhonna Collins; Amber O Molnar; Richard Hae; Daisy Kosa; Louise Moist; Deborah Zimmerman; Charmaine Lok

doi:10.1053/j.ajkd.2024.11.006

Patient and Healthcare Provider Perspectives on Showering for Patients With Hemodialysis Central Venous Catheters: A Survey Study

Am J Kidney Dis. 2025 Jan 10:S0272-6386(25)00008-3. doi: 10.1053/j.ajkd.2024.11.006. Online ahead of print.

Authors

Jhonna Collins¹, Amber O Molnar², Richard Hae¹, Daisy Kosa³, Louise Moist⁴, Deborah Zimmerman⁵, Charmaine Lok⁶

Affiliations

¹ Division of Nephrology, Department of Medicine, McMaster University, Hamilton, ON, Canada.
² Division of Nephrology, Department of Medicine, McMaster University, Hamilton, ON, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Population Heath Research Institute, McMaster University/Hamilton Health Sciences, Hamilton, Ontario, Canada. Electronic address: amolnar@stjosham.on.ca.
³ Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Kidney CARE Network International, Toronto, ON, Canada.
⁴ Division of Nephrology, Department of Medicine, Schulich School of medicine and Dentistry, Western University, London, ON, Canada.
⁵ Division of Nephrology, Department of Medicine, University, of Ottawa, Ottawa, ON, Canada.
⁶ Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Kidney CARE Network International, Toronto, ON, Canada; Division of Nephrology, Department of Medicine, University of Toronto, Toronto, ON, Canada.

PMID: 39800306
DOI: 10.1053/j.ajkd.2024.11.006

Abstract

Rationale & objective: Patients on hemodialysis using a central venous catheter (CVC) are often advised not to shower due to infection risk. This study aimed to assess practices and attitudes of patients and healthcare providers about showering with CVCs.

Study design: Survey study.

Setting & participants: Online survey administered to members of the Canadian Society of Nephrology (CSN, n=972) and two international professional societies (convenience sample). Pen and paper survey administered to patients on maintenance hemodialysis with CVCs able to comprehend English from two hemodialysis programs in Ontario, Canada that advise patients not to shower (St Joseph's Healthcare Hamilton [SJHH], n=119, and University Health Network, Toronto [number of patients asked to complete surveys unavailable]).

Analytical approach: Descriptive statistics.

Results: 304 healthcare provider respondents (CSN response rate 26%). The most common recommendations were strongly against or against showering (45%). Catheter-related bacteremia (CRB) was ranked as the most important outcome (60%). Most respondents (53%) thought that a well conducted prospective cohort study demonstrating improvement in a patient reported outcome with no obvious increase in CRB would reduce the frequency of advice to avoid showering. There were 89 patient respondents (SJHH response rate 45%); 69% were currently showering, and 74% reported "strongly agree" or "agree" to the statement "I want to shower". Prevention of infection was most important to patients in terms of catheter care (78%). 35% of patients would be willing to participate in a shower study.

Limitations: Low response rate. Response rate unavailable from Toronto dialysis units. Exclusion of non-English-speaking patients.

Conclusions: There is variability in personal hygiene recommendations to patients with CVCs, highlighting the need for high quality evidence in this area. A rigorous prospective study examining patient-reported outcomes and CVC-related infections is needed prior to recommending to patients with a CVC that showering is safe.

Keywords: central venous catheter (CVC); dialysis access; hemodialysis; hygiene; quality of life; shower.