title: Prospective surveillance for primary bloodstream infections occurring in Canadian hemodialysis units.
abstract: OBJECTIVE
  Bloodstream infections are a major cause of morbidity and mortality in patients receiving long-term hemodialysis. We wanted to determine the incidence of hemodialysis-related bloodstream infections in Canadian centers participating in the Canadian Nosocomial Infection Surveillance Program.
  
  
  METHODS
  Prospective surveillance for hemodialysis-related bloodstream infections was performed in 11 centers during a 6-month period. Bloodstream infections were defined by published criteria. Hemodialysis denominators included the number of dialysis procedures, the number of patient-days on dialysis, and the frequencies of different types of vascular access.
  
  
  RESULTS
  There were 184 bloodstream infections in 133,158 dialysis procedures (1.4 per 1,000) and 316,953 patient-days (0.6 per 1,000). Hemodialysis access through arteriovenous (AV) fistulae was associated with the lowest risk for bloodstream infection (0.2 per 1,000 dialysis procedures). The relative risk for infection was 2.5 with AV graft access, 15.5 with cuffed and tunneled central venous catheter (CVC) access, and 22.5 with uncuffed CVC access (P < .001). There was marked variation among the 11 centers in the means of vascular access used for hemodialysis. Significant variation in infection rates was observed among the centers when controlling for types of access.
  
  
  CONCLUSIONS
  There was a hierarchy of risk of hemodialysis-related bloodstream infection according to type of vascular access. There was significant variation in the type of vascular access being used among the Canadian hemodialysis centers, and also variation in access-specific infection rates between centers.
authors.affiliation: Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Taylor
authors.forename: Denise
authors.initials: D
authors.lastname: Gravel
authors.forename: Lynn
authors.initials: L
authors.lastname: Johnston
authors.forename: John
authors.initials: J
authors.lastname: Embil
authors.forename: Donna
authors.initials: D
authors.lastname: Holton
authors.forename: Shirley
authors.initials: S
authors.lastname: Paton
mesh_terms: D000328:Adult; D016470:Bacteremia / Q000453:epidemiology* / Q000382:microbiology; D002170:Canada / Q000453:epidemiology; D002408:Catheters, Indwelling / Q000009:adverse effects; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology; D006801:Humans; D015994:Incidence; D015337:Multicenter Studies as Topic; D011159:Population Surveillance; D011446:Prospective Studies; D006435:Renal Dialysis / Q000009:adverse effects / Q000295:instrumentation / Q000706:statistics & numerical data*