CDC Expert Commentary

Preventing Bloodstream Infection During Hemodialysis

Priti Patel, MD, MPH


March 01, 2011

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Hello. I'm Dr. Priti Patel, a Medical Officer at the Centers for Disease Control and Prevention (CDC) and co-author of a recent Vital Signs report on bloodstream infections in hemodialysis patients.

Today, as part of the CDC Expert Video Commentary Series on Medscape I would like to discuss with you a few ways to protect this vulnerable patient population from bloodstream infections.

In the Vital Signs report, we estimated that 37,000 central line-associated bloodstream infections may have occurred in hemodialysis patients in 2008. We know from previous research that healthcare providers and facilities can do several things to prevent bloodstream infections and protect patients.

First, if a central line must be used for dialysis, use an alcohol-based chlorhexidine solution for cleansing the skin before central line insertion and when cleansing the central line insertion site during routine dressing changes.

Second, when accessing the central line for hemodialysis, it is always important to maintain proper aseptic technique. Prior to connecting or disconnecting the line, be sure to perform hand hygiene and use alcohol or other proper antiseptic for cleansing the hub or central line connection.

During dressing changes, use an alcohol-based chlorhexidine solution for cleansing the skin. An antimicrobial ointment such as povidone iodine or polysporin triple should also be applied to the central line insertion site during dressing changes. Use of these ointments has been shown to reduce the incidence of local infection and bloodstream infections.

Third, education is key. Ensure that all staff who perform central line care have been educated and undergo training designed to reinforce proper central line maintenance skills, including aseptic technique. Skills and competencies should be evaluated and practices assessed to ensure optimal uptake and adherence. Tools are available to facilitate audits of central line care practices and hand hygiene and can provide useful information to tailor ongoing education efforts. Patients should also be educated as early as possible about the risks associated with central line use. Work to identify and address barriers to placement of arteriovenous fistulas as well as barriers to timely central line removal.

In addition to educating staff and patients and ensuring implementation of proper infection control procedures, we encourage you to track your progress to enhance your prevention efforts. CDC offers a surveillance module in the National Healthcare Safety Network (NHSN) to outpatient hemodialysis facilities for monitoring and prevention purposes. Facilities can use NHSN to determine their infection rate, compare with rates in other facilities, and follow changes over time. Tracking your infection rates can help to identify potential problem areas, inform timely action, and enhance quality improvement.

Providers should also look for opportunities to collaborate with end-stage renal disease networks, health departments, CDC, and other groups to reduce bloodstream infections in hemodialysis patients. Collaborating and learning from these entities is the best way to identify solutions to commonly encountered barriers to infection prevention in hemodialysis patients. Look to these organizations and fellow dialysis providers involved in prevention initiatives for helpful resources and opportunities to partner.

Through ensuring adherence to evidence-based central line insertion and maintenance practices, tracking our progress towards prevention and collaborating to share our lessons learned and best practices, we can decrease the burden of bloodstream infections in this vulnerable population. Our collective efforts can reduce infections and save lives.

To access the recommendations I've discussed, or for more information about CDC's NHSN and dialysis bloodstream infection prevention collaborative, please see the resources on this page. Thank you.

Web Resources

Provider Training Video: Preventing Bloodstream Infections in Outpatient Hemodialysis Patients: Best Practices for Dialysis Staff

CDC National Healthcare Safety Network (NHSN)

CCD Dialysis Guidelines

CDC Hand Hygiene in Healthcare Settings Guidelines

Audit Tools on Making Dialysis Safe

Priti Patel, MD, MPH , is a Medical Officer in the Division of Healthcare Quality Promotion (DHQP) at the Centers for Disease Control and Prevention (CDC). She began her career with CDC in 2002 as an Epidemic Intelligence Service Officer, where she investigated healthcare-related outbreaks of viral hepatitis and participated in studies to evaluate vaccine efficacy. Dr. Patel currently leads CDC's efforts to prevent healthcare-associated infections among hemodialysis patients. She has authored multiple peer-reviewed publications on topics such as injection safety and infection prevention in ambulatory care settings. She has contributed to the Association for Professionals in Infection Control and Epidemiology's (APIC) Guide to the Elimination of Infections in Hemodialysis. Dr. Patel has also served on the steering committee for a coalition to improve immunizations among dialysis patients and healthcare personnel, and has partnered with other federal agencies to create national infection control standards and prevention targets for hemodialysis centers.


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