CDC Protocols Prevent Dialysis Bloodstream Infections

Protocols developed by the Centers for Disease Control and Prevention (CDC) can help decrease bloodstream infections (BSI) in dialysis patients, according to a new study.

The study, published online ahead of print in the American Journal of Kidney Diseases, found that dialysis facilities following the guidelines had a 32% decrease in the BSI rate overall and a 54% decrease in the rate of vascular access-related BSI.

“Dialysis patients are particularly vulnerable to infections,” said Priti Patel, MD, MPH, head of CDC's dialysis safety efforts. “We now know that it is possible to significantly reduce the infections among dialysis patients by following CDC's checklist 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.”

The study, led by Dr. Patel, analyzed data reported to the National Healthcare Safety Network by 17 outpatient dialysis facilities. Researchers compared infection rates before and after introduction of a set of CDC interventions, which include use of alcohol-based chlorhexidine for catheter exit-site care, staff training, and competency assessments focused on catheter care, vascular access care audits, and adherence to aseptic technique and hand hygiene.

With respect to hand hygiene, CDC recommends that about 30 or more observations of staff members' hand hygiene behavior should be made each month, with observers “trying to ensure that observations are as representative as possible of normal practice at the facility.” Examples of situations when hand hygiene is indicated, according to CDC, is before and after direct patient contact, after completing tasks at one patient station before moving to another, before and after contact with vascular access, before and after dressing changes, and before procedures such as administering intravenous medications.

The guidelines also give recommendations on glove use. For example, they state that, in general, gloves should be worn prior to contact with patients at the treatment station and potentially contaminated surfaces. Gloves should be changed after contact with blood and other body fluids, after completing tasks at one patient station before moving to another, and after contacting a potentially contaminated site before moving to a clean site, the guidelines state.

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