title: Embracing collaboration: a novel strategy for reducing bloodstream infections in outpatient hemodialysis centers.
abstract: BACKGROUND
  The incidence of access-related bloodstream infections (AR-BSIs) in US outpatient hemodialysis centers is unacceptably high. This paper presents the implementation and results achieved from a multi-pronged strategy to reduce AR-BSIs in 1 outpatient hemodialysis center.
  
  
  METHODS
  The intervention, which took place between 2009 and 2011, involved membership in the Centers for Disease Control and Prevention Hemodialysis Bloodstream Infection Prevention Collaborative, implementation of a panel of infection prevention interventions, and use of positive deviance (PD) to engage staff. Changes in the incidence of AR-BSIs and infection prevention process measures between the pre- and postintervention time periods, as well as alterations in the center's social networks, were examined to assess impact.
  
  
  RESULTS
  The incidence of all AR-BSIs dropped from 2.04 per 100 patient-months preintervention to 0.75 (P = .03) after employing the Collaborative interventions and to 0.24 (P < .01) after augmenting the Collaborative interventions with PD. Adherence rates increased significantly in 4 of 5 infection prevention process measure categories. The dialysis center's social networks became more inclusive and connected after implementation of PD.
  
  
  CONCLUSIONS
  Participating in a Collaborative, employing a panel of infection prevention strategies, and engaging employees through PD resulted in a significant decline in AR-BSIs in this facility. Other hemodialysis facilities should consider a similar approach.
authors.affiliation: Billings Clinic, Billings, MT. Electronic address: clindberg@billingsclinic.org.
authors.forename: Curt
authors.initials: C
authors.lastname: Lindberg
authors.forename: Gemma
authors.initials: G
authors.lastname: Downham
authors.forename: Prucia
authors.initials: P
authors.lastname: Buscell
authors.forename: Erin
authors.initials: E
authors.lastname: Jones
authors.forename: Pamela
authors.initials: P
authors.lastname: Peterson
authors.forename: Valdis
authors.initials: V
authors.lastname: Krebs
mesh_terms: D000554:Ambulatory Care Facilities / Q000458:organization & administration*; D016470:Bacteremia / Q000453:epidemiology* / Q000517:prevention & control*; D002487:Centers for Disease Control and Prevention, U.S.; D003299:Cooperative Behavior; D019983:Guideline Adherence; D006282:Health Personnel / Q000193:education*; D006436:Hemodialysis Units, Hospital / Q000458:organization & administration*; D006801:Humans; D015994:Incidence; D017053:Infection Control / Q000379:methods; D010045:Outpatients; D017410:Practice Guidelines as Topic; D006435:Renal Dialysis; D014481:United States / Q000453:epidemiology; D062666:Vascular Access Devices / Q000382:microbiology*