Background: Bloodstream infections (BSIs) are a potentially devastating complication of HD. The CDC estimates 37,000 central line-associated BSIs may have occurred in HD patients in the U.S. in 2008. An improvement project was designed to reduce the rate of CL-ARB in 6 outpatient HD centers.
Methods: Starting in 11/07 surveillance for CL-ARB was done using the CDC NHSN Dialysis module definitions and methods. CL-ARB was defined as a positive blood culture with the suspected source identified as the CL or uncertain, excluding cases with source other than CL or contamination. Starting in 6/09 a series of interventions were made at each center. Interventions included staff engagement and education to improve adherence to recommended practices, monthly feedback of CL-ARB rates, and participation in the CDC Dialysis BSI Prevention Collaborative. The Collaborative interventions included standard catheter care and vascular access practices including use of an observation audit tool to educate and assess compliance, participation in a catheter reduction initiative, use of an alcohol-based chlorhexidine solution for skin antisepsis, implementation of an enhanced catheter hub cleansing method, surveillance of hand hygiene and glove use, use of antimicrobial ointment at catheter exit sites, and patient education.
Results: The combined incidence of CL-ARB at the six centers decreased from 4.8/100 patient-months during the baseline period (11/07-5/09) to 2.0 for the most recent 12 months (4/11–3/12), a 58% reduction (p < 0.001, MidP exact 2-tail). All centers experienced a decrease in their incidence from baseline ranging from 19 to 100% reduction.
Conclusion: We report a sustained reduction in CL-ARB in six dialysis centers although the magnitude of the reduction varied by site; two sites experienced no CL-ARB for more than 12 months. Reductions were associated with use of bedside best practices including standard surveillance methods with frequent feedback, and use of the CDC core interventions.
M. Bushey, None
J. Rimmer, None
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