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Making Dialysis Safer: Simple tools to protect patients from bloodstream infections

Posted on by CDC's Safe Healthcare Blog
Priti R. Patel, MD, MPH
Priti R. Patel, MD, MPH

Author: Priti Patel, MD MPH
Medical Officer
CDC’s Division of Healthcare Quality Promotion

While undergoing dialysis, patients have a lot on their minds. The last thing they need to worry about is getting a bloodstream infection in the process.

In the United States, more than 370,000 people receive long-term hemodialysis. Infection is a leading cause of illness and is the second leading cause of death in these patients.  Bloodstream infections are one of the most serious types of infections dialysis patients can get.  Since 1993, there has been a 40 percent increase in the rates of hospitalizations for bloodstream infection among hemodialysis patients, underscoring the importance of protecting this population.

In 2009, CDC established the CDC Dialysis Bloodstream Infection  Prevention Collaborative, a partnership of freestanding and hospital-based outpatient dialysis facilities from across the country.  These early adopters have seen great success in preventing bloodstream infections among their patients.  Collaborative participants have demonstrated a 31 percent decrease in bloodstream infections and a 53 percent decrease in access-related bloodstream infections when CDC prevention guidelines are implemented.

Now, CDC has expanded its offering of checklist and audit tools for dialysis facilities. This will provide all facilities – not just those formally engaged in the CDC Collaborative –with the simple tools needed to establish and engage in their own prevention efforts.

By working together, we can make a tremendous impact on patients’ lives. We’re learning from the successes of our partners in the dialysis community and are now able to promote these practices for implementation on a more widespread basis in our nation’s dialysis clinics.

Please help us in this quest – take these simple tools and implement them into your daily practice.  And give us your feedback on how we can help you Make Dialysis Safer for all patients.

Posted on by CDC's Safe Healthcare Blog

7 comments on “Making Dialysis Safer: Simple tools to protect patients from bloodstream infections”

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    To. Day my wife know she have dialyse infection she very woory not stop cry please how we can treat this and she will be safer and protect in soon moment . How she come back to good health without dialyse I’m very worry to my wife ?? Ansower me fast please!

    Thankyou a lot

    TEGO caps should be changed according to manufacturer’s instructions. When the caps are changed, the hubs can be scrubbed with antiseptic, similar to the process described in the CDC Collaborative scrub-the-hub protocol. The antiseptic should be allowed to dry prior to attaching a new TEGO cap. For accessing the ports between changes, the access port should be scrubbed with an appropriate antiseptic. Please see the following CDC/HICPAC recommendations (from 2011 Guidelines for the Prevention of Intravascular Catheter-Related Infections accessed at – http://www.cdc.gov/hicpac/BSI/BSI-guidelines-2011.html).

    -Change needleless connectors no more frequently than every 72 hours or according to manufacturers’ recommendations for the purpose of reducing infection rates.
    – Minimize contamination risk by scrubbing the access port with an appropriate antiseptic (chlorhexidine, povidone iodine, an iodophor, or 70% alcohol) and accessing the port only with sterile devices.

    Hospitals remain committed to curtailing CLABSIs and enhancing safety in all clinical settings. Tools such as CUSP go a long way toward accomplishing that goal.

    Gemma Downham reply: We use chlorhexidine applicators, swabsticks, and impregnated swab pads to disinfect catheter sites, hubs, and limbs. We never use multi-dose antiseptic bottles in the chronic hemodialysis unit because of the potential for contamination and use on more than one patient.

    CDC reply: As you have noted, CDC recommends use of a > 0.5% chlorhexidine preparation with alcohol for prepping the catheter exit site during dressing changes. Multidose containers of antiseptic solution can become contaminated and have contributed to outbreaks of bloodstream infections in the past. For this reason, single-use antiseptic applicators are preferred over multidose bottles. For practical reasons, single-use applicators might also be easier to utilize for certain procedures such as catheter exit site skin prep as well as for disinfecting catheter hubs (these procedures might be best performed using antiseptic swabsticks and pads, respectively).

    Thanks for sharing the information. Blood infection is one of the main reason of death. The patients whose kidney unable to purify the blood, they take the help of dialysis for blood purification. You can say dialysis acts as an artificial kidney for the kidney failure patients.

    We are an inpatient hospital dialysis unit and use TEGO caps on our catheters. They are changed once per week. (reducing manipulations at the catheter hub and reducing CRBSI’s). We have a process in place for accessing the ports. What are your recommendations for this process since we do not remove the caps each treatment. Thank you.

    I am trying to figure out what is the best practice to prevent cather related BSI in dialysis patient with permanent catheters.
    As per CDC guidelines 2011 if states
    Prepare clean skin with a >0.5% chlorhexidine preparation with alcohol before central venous catheter and peripheral arterial catheter insertion and during dressing changes.

    I am trying to get it clear either we need to use open solution solution bottle or skin preparation applicator.As far i know the products availability-antiseptic applicator(2% chlorhexidine with 70% alcohol) where as open solution bottle as 500 ml as(0.5% chlorhexine with 70% alchol.
    Can any of you comment and share your practices what is the best and what are you using for skin preparation as we are facing problem with access site infection

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