37,000 Deadly Bloodstream Infections Related to Dialysis

The CDC announced on September 27, 2016, that it is teaming up with a broad coalition of kidney and dialysis organizations to reduce the number of bloodstream infections in dialysis patients. Each year, about 37,000 people get potentially deadly bloodstream infections related to their dialysis treatment.


Bloodstream infections in dialysis patients could be cut in half if dialysis facilities implement the CDC recommendations. For several years, facilities that have followed these recommendations have been successful in reducing bloodstream infections in dialysis patients. The new initiative, known as the Making Dialysis Safer for Patients Coalition, aims to significantly expand the use of the CDC recommendations and tools to improve dialysis patient safety nationwide


"Making evidence-based safety steps a routine part of patient care is a proven strategy to keep dialysis patients safe from bloodstream infections," said CDC Director Tom Frieden, M.D., M.P.H. "We appreciate the new coalition of kidney and dialysis organizations stepping forward to protect the health of dialysis patients."


The coalition aims to decrease bloodstream infections among dialysis patients by promoting the use of the CDC’s Core Interventions for Dialysis Bloodstream Infection Prevention which includes surveillance and feedback using the CDC’s National Healthcare Safety Network (NHSN) monthly surveillance for Bloodstream Infections (BSIs) and other dialysis events and calculating facility rates and comparing rates in other NHSN facilities. Facilities are asked to actively share results with front-line clinical staff.


Core interventions include performing observations of hand hygiene opportunities monthly and sharing results with clinical staff. Another core intervention is performing observations of vascular access care and catheter accessing quarterly. Staff should be assessed for adherence to aseptic technique when connecting and disconnecting catheters and during dressing changes. Results should be shared with clinical staff. Staff should be trained on infection control topics, including access care and aseptic technique. Competency evaluation for skills such as catheter care and accessing should be performed every 6 to 12 months and upon hire. Facilities must 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.


Other interventions are using an alcohol-based chlorhexidine (>0.5%) solution as the first line skin antiseptic agent for central line insertion and during dressing changes, scrubbing catheter hubs with an appropriate antiseptic every time catheter is accessed or disconnected and applying antibiotic ointment or povidone-iodine ointment to catheter exit sites during dressing change.


The CDC recommends using povidone iodine ointment or bacitracin/gramicidin/polymyxin B ointment at the hemodialysis catheter exit site after catheter insertion and at each hemodialysis session. Bacitracin/gramicidin/polymyxin B ointment is not currently available in the United States. Triple antibiotic ointment (bacitracin/neomycin/polymyxin B) is available and might have a similar benefit but studies have not thoroughly evaluated its effect for prevention of bloodstream and exit-site infections.


The Making Dialysis Safer for Patients Coalition is a partnership of healthcare-related organizations, patient advocacy organizations, industry partners, and other public health partners that span the dialysis spectrum. The Coalition aims to prevent bloodstream infections (BSIs) in hemodialysis patients, and increase the use and visibility of CDC evidence based practices.


"Dialysis patients are particularly vulnerable to infections. We want to get lifesaving tools into the right hands to make a real impact on patients’ lives,” said Dr. Priti Patel, medical director of the Making Dialysis Safer for Patients Coalition. "These dialysis leaders are committed to changing the way care is delivered in U.S. dialysis facilities."


See the CDC Announcement


See also Medical Law Perspectives, June 2016 Report: How Risky Is Going to the Hospital? The Dangers and Liabilities of Healthcare-Associated Infections