The Purity Dialysis Center in Watertown, Wis., achieved a 75% decline in health care-associated infections among dialysis patients after participating in an AHRQ-funded project that promotes best practices in hemodialysis care.

The dialysis clinic participated in the AHRQ-funded National Opportunity to Improve Infection Control in End-Stage Renal Disease (NOTICE) Initiative. This project resulted in a toolkit that helps dialysis facilities reduce infection.

Loyola University Medical Center reduces central line bloodstream infections with disinfection routine

Wendy Phillips, RN, unit supervisor at Purity Watertown, said the NOTICE project and AHRQ’s end-stage renal disease (ESRD) Toolkit helped her facility make clinical practice changes that resulted in fewer infections. The toolkit provides facilitators with four instructional modules to teach infection prevention techniques, such as adequate hand hygiene, use of antiseptics, and proper connection and disconnection of catheters. The modules may be modified to meet the needs of individual dialysis centers.

Fighting blood stream infections: a nursing perspective 

“We reviewed the results from NOTICE and decided to revise our policies,” said. Phillips. The facility, which treats about 30 patients per month, saw its annual ESRD number of health care-associated infections decline from eight each year in 2012 and 2013 to just two in 2014.

“The major change we made to reduce infections was in our catheter care policy,” said Phillips. “There is better catheter care now because we introduced the ‘Scrub Hub.'”

This technique requires staff to disinfect the caps and the part of the central venous catheter (CVC) hub—the end of the CVC that connects to the blood lines or cap—that is accessible. Prior to the NOTICE training, Purity Watertown—like many other dialysis facilities—would soak catheters in betadine gauze before hemodialysis staff accessed patients’ catheters. “Scrubbing the hub” was one of a number of aspects of catheter care that the NOTICE project found could potentially reduce vascular access infections in hemodialysis patients.

“No one wanted to touch the hubs due to contamination risk,” Phillips said. “Now we are using a Chlorascrub solution, taking the caps off, and scrubbing the actual tips of the catheter. It’s more thorough.”

Protecting the safety of patients was also an early priority to promote open communication between staff and patients. The NOTICE Check List audit form, which helps monitor infection prevention activities among nursing staff, was one tool that helped achieve that priority.

“We had been working on decreasing the high risk for infection from catheters before the NOTICE project and have made great progress over the last four years,” Phillips said.

Hand hygiene surveillance reduces positive blood cultures in dialysis clinics 

Influenced by this improvement in patient safety, eight other Purity Dialysis Centers across southeastern Wisconsin adopted similar policy changes. The nine Purity Dialysis Centers treat approximately 300 patients each month.