Using infection prevention guidelines from the Centers for Disease Control and Prevention can lead to a 32% decrease in overall bloodstream infections and a 54% decrease in vascular access-related bloodstream infections among dialysis patients, according to the results from the CDC's Dialysis Bloodstream Infection Prevention Collaborative. The agency said approximately 37,000 bloodstream infections occur each year among dialysis patients with central line catheters, at an estimated cost of $23,000 per hospitalization.
(Showers, catheters, and dialysis patients: Nephrology nurses look at best practices)
Published in the American Journal of Kidney Diseases the study looked at data reported to the National Healthcare Safety Network (NHSN) by 17 outpatient dialysis facilities and compared infection rates before and after a set of CDC interventions were consistently used. Interventions included chlorhexidine (an antiseptic for the skin) for catheter exit-site care, staff training and competency assessments focused on catheter care and aseptic technique, hand hygiene and vascular access care audits, and feedback of infection and adherence rates to staff. Dialysis facility staff was also encouraged to use antimicrobial ointment on central line exit sites.
"Dialysis patients often have multiple health concerns, and the last thing they need is a bloodstream infection from dialysis,” said CDC Director Tom Frieden, MD, MPH “These infections are preventable. CDC has simple tools that dialysis facilities can use to help ensure patients have access to the safe healthcare they deserve.”
A dialysis patient is more than 100 times more likely to get a bloodstream infection from a common resistant bacteria, methicillin-resistant Staphylococcus aureus, than other people, according to the CDC. Infections with Staphylococcus aureus can be potentially devastating and can result in hospitalization, death, and serious complications such as endocarditis (heart infection) and osteomyelitis (bone infection).
CDC launched a collaborative project in April 2009 to prevent bloodstream infections among dialysis patients and invited outpatient dialysis centers to participate. CDC and the participating dialysis centers worked together to develop and implement the package of interventions to prevent bloodstream infections. The dialysis facilities tracked bloodstream infections in their patients using CDC’s National Healthcare Safety Network (NHSN), which is now being used by over 5,000 dialysis facilities nationwide for tracking and prevention of healthcare-associated infections.
“Dialysis facilities can implement many of CDC’s recommendations by using a series of checklists and performing observations using audit tools that are currently available on CDC’s website. Additionally, CDC has released a free infection prevention course for dialysis nurses and technicians that reviews CDC recommended practices in a convenient, 1-hour self-guided internet training course that also offers continuing education credits.