Incidence of nosocomial hemodialysis-associated bloodstream infections at a county teaching hospital.
BACKGROUND
Infections are an important cause of morbidity and mortality in patients undergoing hemodialysis. Limited information is to be found regarding nosocomial hemodialysis-associated bloodstream infections (HABSI).


METHODS
We sought to determine the rate of nosocomial HABSI and its associated risk factors at Riverside County Regional Medical Center. Inpatients who received hemodialysis during 2011 and 2012 were included, and outcomes were recorded along with risk factors. Data was analyzed with SPSS Inc software.


RESULTS
A total of 619 patients was included. Fourteen HABSI were detected, with a rate of 3.33/1,000 hemodialysis sessions and 1.03/1,000 patient-days. An association was detected between HABSI and vascular access type (highest risk with nontunneled catheters), length of hospital stay, number of hemodialysis sessions, and hemoglobin A1c level. A correlation was also noted between HABSI because of MRSA and colonization of nares with MRSA. A predominance of staphylococci infections was detected.


CONCLUSIONS
The rate of HABSI observed at Riverside County Regional Medical Center was lower than similar studies (2.5 per 1,000 patient-days and 3.95 per 1,000 hemodialysis sessions). The most important risk factors were determined to be nontunneled catheters, hemoglobin A1c greater than 7%, and nares colonization for HABSI because of MRSA. Infection prevention efforts in the inpatient hemodialysis population should focus on control of hyperglycemia and decolonization of nares from MRSA.
Infection Prevention and Control Department, Riverside County Regional Medical Center, Riverside, CA.
Matías
M
Gnass
Infection Prevention and Control Department, Riverside County Regional Medical Center, Riverside, CA.
Caren
C
Gielish
Infection Prevention and Control Department, Riverside County Regional Medical Center, Riverside, CA. Electronic address: Siacostagnass@gmail.com.
Silvia
S
Acosta-Gnass
D000328:Adult; D000368:Aged; D002140:California / Q000453:epidemiology; D003428:Cross Infection / Q000453:epidemiology*; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000009:adverse effects*; D012307:Risk Factors
Dialysis vascular access; HbA1c; MRSA