COMMENTARY

Preventing Bloodstream Infections in Dialysis Patients

Priti R. Patel, MD, MPH

Disclosures

August 12, 2013

Editorial Collaboration

Medscape &

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Bloodstream Infections in Dialysis Patients

Hello. I am Dr. Priti Patel, lead of dialysis safety at the Centers for Disease Control and Prevention (CDC). I am pleased to speak with you as part of the CDC Expert Commentary Series on Medscape.

Today I would like to discuss a set of infection control practices that can potentially cut in half bloodstream infections among dialysis patients. Infection is a leading cause of hospitalization and death in hemodialysis patients. Bloodstream infections are a particularly severe form of infection that can occur in these patients, with devastating outcomes.

We estimate that about 37,000 bloodstream infections occur among dialysis patients with central lines each year, costing approximately $23,000 per hospitalization. This is a substantial burden and cost to our health system.

In 2009, we launched a collaborative project to prevent bloodstream infections among dialysis patients and invited outpatient dialysis centers to participate. CDC and the participating dialysis centers worked together to develop and implement a package of 9 interventions to prevent bloodstream infections.

Dialysis Infection Prevention Strategies

We tracked bloodstream infections using CDC's National Healthcare Safety Network (NHSN). Participating facilities also:

Reported to NHSN;

Performed monthly hand hygiene observations;

Performed regular observations of vascular access care and catheter accessing;

Trained staff on infection control topics, including access care and use of aseptic technique;

Provided standardized education to their patients on infection prevention strategies;

Worked to identify and address barriers to permanent vascular access placement and catheter removal;

Used chlorhexidine for catheter exit-site skin antisepsis during dressing changes;

Scrubbed catheter hubs with an appropriate antiseptic before accessing the lines; and

Applied an antibiotic ointment or povidone-iodine ointment to catheter exit sites during dressing changes.

The 17 outpatient dialysis facilities in the collaborative demonstrated a 32% reduction in overall bloodstream infections and a 54% drop in access-related bloodstream infections using the recommended interventions described above. Vascular access-related bloodstream infections are those related to devices used to access the bloodstream for hemodialysis. The study was published in the American Journal of Kidney Diseases.[1]

Wider implementation of these practices could help save lives and reduce excess healthcare spending. Our study findings suggest that with improved implementation of evidence-based practices, it is possible to significantly reduce bloodstream infections in hemodialysis centers. If other facilities nationwide were able to replicate these successes, the result would be a substantial reduction in bloodstream infections and related hospitalizations.

For more information about what you can do to protect your dialysis patients from infections, or to implement the tools used in this collaborative, please see the links below.

Thank you.

Web Resources

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

CDC Dialysis Safety

CDC Dialysis Safety: Infection Prevention Tools

Priti R. Patel, MD, MPH, is a medical officer who serves as the Dialysis Activity Leader within the Division of Healthcare Quality Promotion at the Centers for Disease Control and Prevention (CDC). She completed her internal medicine residency at the Hospital of the University of Pennsylvania, and then served as an Epidemic Intelligence Service Officer at CDC. She subsequently completed a preventive medicine residency at CDC and the Maryland Department of Health and Mental Hygiene. In her 11 years at CDC, Dr. Patel has supervised multiple outbreaks of healthcare-related infections and other adverse events in dialysis centers and has authored more than 50 peer-reviewed journal articles, book chapters, and other scientific publications. Dr. Patel currently leads the CDC's prevention, surveillance, and response activities related to dialysis patient safety. She oversees the Dialysis Event Surveillance system in NHSN and is a co-founder of CDC's Dialysis Bloodstream Infection Prevention Collaborative.

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