Following CDC protocols reduces dialysis bloodstream infections

Outpatient hemodialysis facilities realized a 32% decrease in overall bloodstream infections and a 54% decrease in vascular access-related bloodstream infections after Centers for Disease Control and Prevention (CDC) guidelines were used, according to a new study.

Published online May 15, 2013, in the American Journal of Kidney Diseases, the study was led by Priti R. Patel, MD, MPH, with the CDC.

Researchers analyzed up to 12 months of preintervention and 15 months of intervention data from 17 outpatient hemodialysis facilities.  Bloodstream infection (BSI) rates decreased 32%. BSI and access-related BSI rates were 1.09 and 0.73 events per 100 patient-months during the preintervention period and 0.89 and 0.42 events per 100 patient months during the intervention period.

“These findings suggest that improved implementation of recommended practices and reduce BSIs in hemodialysis centers,” Dr Patel wrote.

The BSI rates were significantly reduced by following the guidelines from CDC’s Dialysis Bloodstream Infection Prevention Collaborative.

The guidelines include:

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 (eg, 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.

** If closed needleless connector device is used, disinfect connector device per manufacturer’s instructions.

*** See information on selecting an antimicrobial ointment for hemodialysis catheter exit sites (selecting an antimicrobial ointment). Use of chlorhexidine-impregnated sponge dressing might be an alternative.