title: Outbreak of hemodialysis vascular access site infections related to malfunctioning permanent tunneled catheters: making the case for active infection surveillance.
abstract: OBJECTIVE
  To describe an outbreak of infections with permanent cuffed hemodialysis catheters recognized through ongoing surveillance and related to a specific malfunctioning permanent catheter.
  
  
  METHODS
  The outbreak was suspected from the results of prospective infection surveillance and confirmed by a retrospective cohort study using medical records for patients receiving dialysis between April 1, 1999, and March 31, 2000.
  
  
  METHODS
  Integrated network of six outpatient hemodialysis facilities in southern Idaho and eastern Oregon.
  
  
  METHODS
  Outpatients receiving long-term hemodialysis.
  
  
  RESULTS
  During the 18 months prior to the outbreak, the overall infection rate was 4.1 infections per 1,000 dialysis sessions with a catheter rate of 8.9 per 1,000 dialysis sessions. During the 7 months of the outbreak, the overall rate increased to 5.8 per 1,000 dialysis sessions, whereas the catheter rate increased to 18.1 per 1,000 dialysis sessions. Reports of malfunctioning "Brand A" catheters prompted discontinuation of their placement. A manufacturer recall occurred in April 2000. During the 14 months after the outbreak, the overall infection rate decreased to 3.3 per 1,000 dialysis sessions and the catheter rate to 10.8 per 1,000 dialysis sessions. A 12-month retrospective cohort study recognized 96 patients with an identifiable catheter brand and 48 infections. Of these, 27 (56%) occurred in patients with Brand A catheters. The relative risk for infection when compared with other catheter brands was 1.96 (95% confidence interval, 1.32 to 2.92; P < .001).
  
  
  CONCLUSIONS
  Ongoing infection surveillance in hemodialysis facilities can identify specific device-related outbreaks of infections and promote interventions to reduce infectious complications and promote patient safety. Surveillance for vascular access site infections is recommended as a routine activity in hemodialysis facilities.
authors.affiliation: PRO-West, Boise, ID 83712-7756, USA.
authors.forename: Elizabeth L
authors.initials: EL
authors.lastname: Hannah
authors.forename: Kurt B
authors.initials: KB
authors.lastname: Stevenson
authors.forename: Connie A
authors.initials: CA
authors.lastname: Lowder
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Adcox
authors.forename: Robert L
authors.initials: RL
authors.lastname: Davidson
authors.forename: Michael C
authors.initials: MC
authors.lastname: Mallea
authors.forename: Nagraj
authors.initials: N
authors.lastname: Narasimhan
authors.forename: Jon P
authors.initials: JP
authors.lastname: Wagnild
mesh_terms: D002408:Catheters, Indwelling / Q000009:adverse effects*; D015331:Cohort Studies; D003428:Cross Infection / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D004196:Disease Outbreaks / Q000517:prevention & control / Q000706:statistics & numerical data*; D004868:Equipment Failure; D006801:Humans; D007061:Idaho / Q000453:epidemiology; D017053:Infection Control / Q000379:methods*; D009922:Oregon / Q000453:epidemiology; D011159:Population Surveillance; D011446:Prospective Studies; D006435:Renal Dialysis / Q000295:instrumentation*; D012189:Retrospective Studies; D012306:Risk; D012307:Risk Factors