title: Bloodstream infection rates in outpatient hemodialysis facilities participating in a collaborative prevention effort: a quality improvement report.
abstract: BACKGROUND
  Bloodstream infections (BSIs) cause substantial morbidity in hemodialysis patients. In 2009, the US Centers for Disease Control and Prevention (CDC) sponsored a collaborative project to prevent BSIs in outpatient hemodialysis facilities. We sought to assess the impact of a set of interventions on BSI and access-related BSI rates in participating facilities using data reported to the CDC's National Healthcare Safety Network (NHSN).
  
  
  METHODS
  Quality improvement project.
  
  
  METHODS
  Patients in 17 outpatient hemodialysis facilities that volunteered to participate.
  
  
  METHODS
  Facilities reported monthly event and denominator data to NHSN, received guidance from the CDC, and implemented an evidence-based intervention package that included chlorhexidine use for catheter exit-site care, staff training and competency assessments focused on catheter care and aseptic technique, hand hygiene and vascular access care audits, and feedback of infection and adherence rates to staff.
  
  
  RESULTS
  Crude and modeled BSI and access-related BSI rates.
  
  
  METHODS
  Up to 12 months of preintervention (January 2009 through December 2009) and 15 months of intervention period (January 2010 through March 2011) data from participating centers were analyzed. Segmented regression analysis was used to assess changes in BSI and access-related BSI rates during the preintervention and intervention periods.
  
  
  RESULTS
  Most (65%) participating facilities were hospital based. Pooled mean BSI and access-related BSI rates were 1.09 and 0.73 events per 100 patient-months during the preintervention period and 0.89 and 0.42 events per 100 patient-months during the intervention period, respectively. Modeled rates decreased 32% (P = 0.01) for BSIs and 54% (P < 0.001) for access-related BSIs at the start of the intervention period.
  
  
  CONCLUSIONS
  Participating facilities were not representative of all outpatient hemodialysis centers nationally. There was no control arm to this quality improvement project.
  
  
  CONCLUSIONS
  Facilities participating in a collaborative successfully decreased their BSI and access-related BSI rates. The decreased rates appeared to be maintained in the intervention period. These findings suggest that improved implementation of recommended practices can reduce BSIs in hemodialysis centers.
authors.affiliation: Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. ppatel@cdc.gov
authors.forename: Priti R
authors.initials: PR
authors.lastname: Patel
authors.forename: Sarah H
authors.initials: SH
authors.lastname: Yi
authors.forename: Stephanie
authors.initials: S
authors.lastname: Booth
authors.forename: Virginia
authors.initials: V
authors.lastname: Bren
authors.forename: Gemma
authors.initials: G
authors.lastname: Downham
authors.forename: Sally
authors.initials: S
authors.lastname: Hess
authors.forename: Karen
authors.initials: K
authors.lastname: Kelley
authors.forename: Mary
authors.initials: M
authors.lastname: Lincoln
authors.forename: Kathy
authors.initials: K
authors.lastname: Morrissette
authors.forename: Curt
authors.initials: C
authors.lastname: Lindberg
authors.forename: John A
authors.initials: JA
authors.lastname: Jernigan
authors.forename: Alexander J
authors.initials: AJ
authors.lastname: Kallen
mesh_terms: D016470:Bacteremia / Q000453:epidemiology*; D055499:Catheter-Related Infections / Q000453:epidemiology* / Q000517:prevention & control*; D006801:Humans; D010045:Outpatients; D058996:Quality Improvement; D006435:Renal Dialysis; D062666:Vascular Access Devices / Q000009:adverse effects*
keywords: Dialysis; bacteremia; catheter-related infections; infection control; quality improvement; vascular access devices