Infection Prevention and Control in Dialysis Settings

Dialysis treatments put patients at an increased risk for healthcare-associated infections (HAIs). Dialysis treatments require the bloodstream to be frequently accessed by needles and catheters (tubes) which can provide a way for germs to enter the body, especially if proper personal protective equipment (PPE) is not worn or proper infection prevention steps (such as hand hygiene and proper disinfection of the access site) are not taken. Bloodstream infections (BSIs) are the most common HAI in dialysis patients.

In the Centers for Disease Control and Prevention (CDC) Vital Signs: Preventing Bloodstream Infections in People on Dialysis, February 2023 issue, it is noted that over 800,000 people in the U.S. are living with end-stage renal disease (ESRD), and that over 14,000 bloodstream infections occurred in those patients in 2020. The most commonly reported HAI in dialysis is called Staphylococcus aureus (staph).

Source: Center for Disease Control and Prevention (CDC)

Best Practices for Preventing Bloodstream Infections (BSI) in Dialysis Settings?

The CDC offers recommendations, known as the Core Interventions, as a proven approach to prevent BSIs in outpatient dialysis facilities. Following proper infection prevention and control procedures in the dialysis facility can protect patients and reduce the risk of BSIs.

Core Interventions include:

• Surveillance and feedback.
• Hand hygiene observations.
• Catheter/vascular access care observations.
• Staff education and competency.
• Patient education/engagement.
• Catheter reduction.
• Chlorhexidine for skin antisepsis.
• Catheter hub disinfection: Scrub-the-Hub Protocol.
• Antimicrobial ointment.

Infection Prevention in Dialysis Settings Training for Providers

CDC's training, Infection Prevention in Dialysis Settings is a self-paced course on infection prevention and control for dialysis technicians, nurses, and other outpatient dialysis healthcare providers. This course also qualifies for continuing education credits through the Center for Disease Control and Prevention (CDC) Train website.

CDC’s Preventing Bloodstream Infections in Outpatient Hemodialysis Patients is a video with five segments on best practices to prevent infection in patients with catheters, fistulas, or grafts. It also includes segments on hand hygiene, glove use and dialysis station disinfection. The video is intended to be used by outpatient hemodialysis facilities as an educational tool to help remind their frontline staff, including technicians and nurses, about infection prevention measures.

Project Firstline Infection Control in Dialysis Settings Education Modules for Providers

The American Society of Nephrology (ASN) partnered with the American Medical Association (AMA) and the CDC’s national infection control training collaborative, Project Firstline, to develop a four-part series of educational modules that show the importance of infection prevention in the dialysis setting. The modules include the steps that facility staff should take to assist in protecting their patients and everyone that they come in contact with.

The titles of these modules are:

• Hand Hygiene for Infection Prevention in a Dialysis Setting.
• Personal Protective Equipment (PPE) for Infection Prevention in a Dialysis Setting.
• Injection Safety for Infection Prevention in a Dialysis Setting.
• Environmental Cleaning and Disinfection for Infection Prevention in a Dialysis. Setting.

Making Dialysis Safer for Patients Coalition

CDC’s Making Dialysis Safer for Patients Coalition is a partnership of organizations and individuals that aim to prevent BSIs in patients on dialysis. The Coalition has resources to prevent infections in dialysis patients and improve infection prevention practices to reduce infection rates. Free copies of these tools can be ordered by searching for “dialysis” at CDC-INFO on Demand.

The Coalition also has webinars posted as part of the "Tune in to Safe Healthcare" webinar series. Some of the webinars include:

• Making Dialysis Safer for Patients: Innovative Approaches to Hand Hygiene.
• Making Dialysis Safer for Patients: Optimizing Antibiotic Use in Outpatient Hemodialysis Facilities.
• Empowering Nurses to Protect Themselves and Their Patients: Exploring Best Practices in Injection Safety.
• Making Dialysis Safer for Patients: Bloodstream Infections, Wall Boxes, and Lessons Learned.

The CDC’s Speak Up: Making Dialysis Safer for Patients video highlights the journey of two patients on dialysis who feel empowered to speak up and share concerns they may have about their dialysis treatment in order to prevent infections. Capturing the experiences of these empowered dialysis patients is important to raise patient and staff awareness, about how they can work together to improve infection prevention efforts and dialysis patient safety.

End-Stage Renal Disease (ESRD) Network

The Centers for Medicare & Medicaid Services' (CMS) ESRD Network Programs are responsible for developing local objectives and goals that support national priorities mandated by CMS and the legislative requirements of Congress. The Network of the Ohio River Valley (Network 9) services dialysis patients and providers in Indiana, Kentucky, and Ohio. ESRD Networks are required to conduct specific quality improvement activities focused on patient care, maintaining a patient registry, providing educational materials, and investigating patient grievances.