CDC Guidelines Could Cut Bloodstream Infections From Dialysis
TUESDAY May 14, 2013 -- Dialysis facilities could cut bloodstream infection rates among their patients by up to half by following a set of recommendations from the U.S. Centers for Disease Control and Prevention, according to new research.
The CDC suggested that adopting their protocols could save lives and reduce health care costs.
"Dialysis patients often have multiple health concerns, and the last thing they need is a bloodstream infection from dialysis," CDC director Dr. Tom Frieden said in an agency news release. "These infections are preventable. CDC has simple tools that dialysis facilities can use to help ensure patients have access to the safe health care they deserve."
In 2010 alone, more than 380,000 people in the United States required hemodialysis for end-stage kidney disease. In the majority of patients, this treatment is started with a central line, which is a tube that a doctor usually places in a large vein in the neck or chest. The researchers noted, however, if a central line is not placed correctly or kept clean, it can provide a portal for germs to infect the body and the blood.
Although other forms of vascular access used for hemodialysis -- such as arteriovenous fistulas and grafts -- are less risky than central lines, they can also result in bloodstream infections, the experts noted.
Over the past two decades, the rate of hospitalization for bloodstream infections has increased 51 percent. The researchers pointed out that dialysis patients are more than 100 times more likely to get a potentially deadly bloodstream infection from a common resistant bacteria, methicillin-resistant Staphylococcus aureus.
To address this growing public health issue, in April 2009, the CDC invited outpatient dialysis centers to participate in a collaborative project aimed at preventing bloodstream infections among dialysis patients.
Among the CDC's guidelines:
- Use the skin antiseptic chlorhexidine for catheter exit-site care.
- Conduct staff training and competency assessments, specifically on catheter care and aseptic technique.
- Perform hand hygiene and vascular access care audits.
- Provide feedback to staff on infection and adherence rates.
- Use antimicrobial ointment on central line exit sites
In conducting the study, researchers analyzed data compiled from 17 outpatient dialysis facilities by the National Healthcare Safety Network. The investigators compared infection rates before and after a set of protocols from the CDC were consistently used.
Following the CDC protocols resulted in a 32 percent reduction in overall bloodstream infections and a 54 percent decrease in vascular access-related bloodstream infections (those related to devices used to access the bloodstream for hemodialysis).
"Dialysis patients are particularly vulnerable to infections," Dr. Priti Patel, head of CDC's dialysis safety efforts, said in the CDC news release. "We now know it is possible to significantly reduce the infections among dialysis patients by following CDC's checklists and tools. If all dialysis facilities nationwide were using the CDC interventions, we could see dramatic reductions in infections and adverse outcomes in this population."
Roughly 37,000 bloodstream infections develop each year among dialysis patients with central lines. It's estimated these infections cost $23,000 per hospitalization.
The U.S. Department of Health and Human Services has made the prevention of bloodstream infections among dialysis patients a national priority. The dialysis facilities involved in the study tracked the bloodstream infections that developed in their patients. The data compiled in the CDC's National Healthcare Safety Network is now also used by more than 5,000 dialysis facilities nationwide to track and prevent health care-related infections.
The CDC's guidelines can be implemented in dialysis facilities through a series of checklists and using audit tools available on the CDC's website. The CDC also offers a one-hour online training course on infection prevention for dialysis nurses and technicians. This course also offers continuing education credits.
The study was published in the current issue of the American Journal of Kidney Diseases.
The U.S. National Library of Medicine has more about dialysis.
Posted: May 2013
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