Bloodstream infections are the #2 killer of dialysis patients in the United States, but they are preventable. Improving infection control can have a tremendous impact on the mortality rates of dialysis patients, and the steps are fairly simple.

Over the last several months, NN&I has had extensive coverage of infection control. The Centers for Disease Control and Prevention has reported an increase in Hepatitis C infection. A recent survey of 116 ambulatory care nurses found that only 17% of the reported compliance with standard precautions for infection prevention.

And in July, core survey data showed the number one area of noncompliance for dialysis clinics is related to poor hand hygiene. Dialysis staff, including physicians, are not consistently following universal precautions—washing hands between patients and changing gloves as needed. That tag has remained the #1 citation for years.

I’ve spent the last month asking readers and authors what can be done to improve infection control in dialysis clinics. And the answers are not surprising: Increase staff education, create and follow checklists, make hand-washing easily accessible to busy dialysis staff, empower patients to advocate for their own safety without fear of reprisal. And infection control must be an important enough issue that the proper time is provided to each staff member to wash their hands and follow a disinfection routine. A common theme in much of this is that these actions must start at the top.

“It was our collected opinion that the treating physician should not only follow the above guidelines but should be a model of compliance with infection control practices for the staff of the facility,” Dr. Don Willamson, the medical director for American Renal Associates, and Dr. Stan Lindenfeld, the medical director for US Renal Care, wrote in our CMO Initiative series.

“In addition, failure of a physician to follow these guidelines in the dialysis facility should be noted by either the facility administrator or the charge nurse and pointed out to the physician in a private setting. There should not be any retribution or negative consequences for these staff members from the physician as a result of their communication on this issue. Any breach of this by the physician should be reported to the governing body to be dealt with appropriately,” the CMOs said.

I think this same courtesy should be extended to patients. But they need to be able to speak up the moment they see the compliance breach happen. Every patient should have the right to ask their nurse or PCT to wash their hands, without being labeled non-compliant or combative.

In order to create this culture, leadership must make the first move.