CHICAGO – The Nephrologists Transforming Dialysis Safety (NTDS) Initiative aims to do in three years what the renal community has failed to do in decades: reduce the infection rate in dialysis clinics to zero.

Infections are the number 2 cause of death in dialysis patients, after heart disease. But the dialysis community has made improvements in reducing mortality from heart disease and has made no such headway with infection control.

The new initiative, funded by the U.S. Centers for Disease Control and Prevention, aims to transform the way the community detects and manages infection. Infection prevention has to be foremost in nephrologists’ minds when they are doing their rounds, said Initiative Chair Alan Kliger at a town hall meeting at the American Society of Nephrology’s 2016 Kidney Week.

Kliger said they were seeking fresh ideas from the audience, and reserved half of the session time to audience questions and comments.

“We have to start thinking about this problem differently,” said Leslie Wong, MD, vice chair, for the nephrology and hypertension department at the Cleveland Clinic. Wong is chair of the Quality, Assessment, Improvement and Education working group for the initiative and gave an impassioned speech during the session. “Improving infection control in dialysis clinics is about culture change.

“I am about 1/3 of the way through my career and I have repeatedly experienced a paradox when it comes to infections in dialysis: We know what we are supposed to do, but we don’t, we can’t, or we won’t do it. Instead we shrug our shoulders, we shake our heads, we throw up our hands and we rationalize why the infections keep happening. I don’t want to practice in this kind of environment for the remaining 2/3 of my career.”

So how does the renal community reduce infection rates? “It’s not an issue of not having the right resources,” Kliger said.

The panel and the audience had some ideas:

  • Patients must be at the center of the infection control efforts. “if we don’t empower our patients to be the leader of the safety team, we have failed,” said Kliger.
  • The hierarchy needs to be shaken up. Nurses, PCTs, and patients need to feel safe to speak up and challenge the actions of the physician if protocols are not followed. “We are used to being the ones who dictate the orders,” Wong said. The team structure needs to be challenged, and physicians need to examine their role within the care team. “When you mention the term compliance in a dialysis facility, it evokes an immediate negative reaction,” Wong said
  • Protocols within every clinic need to be clear. Do you know who is responsible for reporting an infection to the state and federal authorities within your clinic?
  • Hand washing and other measures like wearing gloves and gowns need to be taken more seriously. Nephrologists must stop using the excuse that they “are not touching the patient.” At one point an audience member asked what innovations the CDC is working on for infection control technology, and Kliger quickly responded “Before we talk about innovations, we need to follow hand hygiene.” A representative from the CDC, did respond to the question, and there are no miracle innovations in the pipeline.
  • One person in every clinic needs to be in charge of infection control.
  • Panelists repeatedly referred to the airline industry as an example of safety culture. Fatal accidents have dropped every decade, despite the significant increase in airline travel.
  • Training needs to emphasize the importance of infection control. Every fellow needs to enter dialysis with infection control as one of his/her top priorities. “The new generation needs to have these practices engrained in their DNA,” one participant said.

“Sometimes we feel like we are the only ones that care,” Wong said. “It’s tempting to blame the surgeon, to blame the PCT, and we often blame management. And yes, sometimes we even blame the patient. Something has to change, the status quo is simply not acceptable.”

This change, according to the initiative, needs to start with the nephrologist.

More information no the initiative is available here.