1546. Surveillance for Vascular Access-Related Bloodstream Infections in Hemodialysis Outpatients According to Access Type and Primary Provider in Two Counties:  California, 2011-2012
Session: Poster Abstract Session: Infections in Non-Acute Healthcare Settings
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
  • IDWeek_poster_HD Centers v6.pdf (168.1 kB)
  • Background: In October 2011, a Health Maintenance Organization (HMO A) hospital noted a cluster of 11 outpatients since July with vascular access-related bloodstream infections (VABSI) associated with one hemodialysis provider (HDP X) in Napa and Solano counties.  Local and state public health agencies were notified. 

    Methods: Patient census by access type and blood culture data were obtained from HMO A and non-HMO A outpatients utilizing HDP X records.  VABSI rates were compared with rate ratios and 95% Confidence Intervals (CI); baseline (January – June) rates were compared to the investigative period (July – October).  Infection control practices were observed and recommendations provided.    

    Results: Eight HDP X centers servicing HMO A outpatients were included; infection control audits were conducted at three centers.  Reconciliation of blood culture data from HMO A, HDP X’s laboratory and two independent laboratories took four months.  Overall VABSI rates ranged from 0 – 0.19/100 patient-months.  By access type, total number of HDP X outpatients and rates of VABSI were as follows:  Central Venous Catheter (CVC) (n=2378) 0.12/100 patient-months; Arteriovenous Fistula (AVF) Rope Ladder cannulation (n=1849) 0.05/100 patient-months; AVF Buttonhole cannulation (n=1758) 0.09/100 patient-months; and Arteriovenous Graft (AVG) (n=960) 0.01/100 patient-months.  There was a significantly higher VABSI rate in the investigative period compared to the baseline (0.26 vs. 0.11; Rate Ratio 2.39: 95% CI 1.40 – 4.07), due in part to HMO A outpatients with CVCs compared to HMO A outpatients without CVCs (0.72 vs. 0.2; Rate Ratio 13.63: 95% CI 5.29 – 36.08).  Audits revealed breaches in AVF/AVG cannulation including lack of “clean-to-dirty” awareness and incomplete cleaning of patient care stations, but none in CVC access/disconnection and exit site care.   

    Conclusion: Although we revealed low VABSI rates overall, there was an increase in VABSI rates during the investigative period noted in HMO A outpatients with CVCs; however, no CVC breaches were identified.  Recommendations included improved infection surveillance by HDP X according to access type with reconciliation of blood culture reports from all laboratories for timely detection and response to VABSIs.

    Kavita K. Trivedi, MD1, Rebecca Siiteri, RN, MPH1, Leah Carlon, MPH2 and Jon Rosenberg, MD1, (1)Healthcare Associated Infections Program, California Department of Public Health, Richmond, CA, (2)Emergency Services Bureau, Solano County Public Health, Fairfield, CA


    K. K. Trivedi, None

    R. Siiteri, None

    L. Carlon, None

    J. Rosenberg, None

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