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While hospital ICUs have made significant strides in reducing central line associated blood stream infections, hemodialysis settings remain a dangerous area for patient care. Some 37,000 bloodstream infections occur each year among dialysis patients with central lines, posing a risk of hospitalization and death. According to the U.S. Renal Data System, the rate of hospitalization for BSI per 1,000 hemodialysis patient-years has increased 51% since 1994. That’s at a cost of some $23,000 per hospitalization.
Can this trend be turned much as it has been in hospital ICUs? The short answer is yes. An infection prevention collaborative in dialysis settings decreased BSIs by 32% overall and cut vascular access-related bloodstream infections by 54%, the Centers for Disease Control and Prevention reports in a new study . The study reflects the results of the CDC’s Dialysis Bloodstream Infection Prevention Collaborative, and includes such infection prevention measures as:
1. Surveillance and feedback using NHSN
Conduct monthly surveillance for BSIs and other dialysis events using CDC’s National Healthcare Safety Network (NHSN). Calculate facility rates and compare to rates in other NHSN facilities. Actively share results with front-line clinical staff.
2. Hand hygiene observations
Perform observations of hand hygiene opportunities monthly and share results with clinical staff.
3. Catheter/vascular access care observations
Perform observations of vascular access care and catheter accessing quarterly. Assess staff adherence to aseptic technique when connecting and disconnecting catheters and during dressing changes. Share results with clinical staff.
4. Staff education and competency
Train staff on infection control topics, including access care and aseptic technique. Perform competency evaluation for skills such as catheter care and accessing every 6-12 months and upon hire.
5. Patient education/engagement
Provide standardized education to all patients on infection prevention topics including vascular access care, hand hygiene, risks related to catheter use, recognizing signs of infection, and instructions for access management when away from the dialysis unit.
6. Catheter reduction
Incorporate efforts (e.g., through patient education, vascular access coordinator) to reduce catheters by identifying and addressing barriers to permanent vascular access placement and catheter removal.
7. Chlorhexidine for skin antisepsis
Use an alcohol-based chlorhexidine (>0.5%) solution as the first line skin antiseptic agent for central line insertion and during dressing changes.*
8. Catheter hub disinfection
Scrub catheter hubs with an appropriate antiseptic after cap is removed and before accessing. Perform every time catheter is accessed or disconnected.**
9. Antimicrobial ointment
Apply antibiotic ointment or povidone-iodine ointment to catheter exit sites during dressing change.***
* Povidone-iodine (preferably with alcohol) or 70% alcohol are alternatives for patients with chlorhexidine intolerance.