Bacteremia in hemodialysis patients

Table 4 Core interventions of dialysis blood stream infections prevention in collaboration with the Centers for Disease Control and Prevention

Surveillance and feedback using NHSN

Conduct monthly surveillance for BSIs and other dialysis events using NHSN-Dialysis Surveillance. Calculate facility rates and compare to rates in other NHSN facilities. Actively share results with front-line clinical staff. See Data Reports on this website (available from: URL: http://www.cdc.gov/dialysis/reports-news/data-reports.html)

Hand hygiene observations

Perform observations of hand hygiene opportunities monthly and share results with clinical staff. See observation protocols for hand hygiene and glove use on this website (available from: URL: http://www.cdc.gov/dialysis/PDFs/collaborative/Hemodialysis-Hand-Hygiene-Observations.pdf)

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

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 mo and upon hire. See staff education on this website (available from: URL: http://www.cdc.gov/dialysis/clinician/index.html)

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. See patient education on this website (available from: URL: http://www.cdc.gov/dialysis/clinician/index.html)

Catheter reduction

Incorporate efforts (e.g., through patient education, vascular access coordinator) to reduce catheters by identifying and addressing barriers to permanent vascular access placement and catheter removal

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. Povidone-iodine (preferably with alcohol) or 70% alcohol are alternatives for patients with chlorhexidine intolerance

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

Antimicrobial ointment

Apply antibiotic ointment or povidone-iodine ointment to catheter exit sites during dressing change. 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

NHSN: National Healthcare Safety Network; BSIs: Blood stream infections.