title: Survey of infection control practices in hemodialysis units: preventing vascular access-associated bloodstream infections.
abstract: OBJECTIVE
  Despite surveillance, the Quebec Healthcare-Associated Infections Surveillance Program saw no improvement in vascular access-associated bloodstream infections in hemodialysis (HD). We aimed to determine the infection control measures recommended and implemented in Quebec's HD units, compliance of local protocols to infection control practice guidelines, and reasons behind the low prevalence of arteriovenous fistulas.
  
  
  METHODS
  An online survey was elaborated on the basis of the Centers for Disease Control and Prevention (CDC) and National Kidney Foundation Kidney Disease Outcomes Quality Initiative guidelines. The questionnaire was validated (construct, content, face validity, and reliability) and sent to all HD units in Quebec (n = 40). Results were analyzed using descriptive statistics, linear regression, and Poisson regression.
  
  
  RESULTS
  Thirty-seven (93%) of 40 HD units participated. Thirty (94%) of the 32 centers where central catheters are inserted have written insertion protocols. Compliance with practice guidelines is good, except for full-body draping during catheter insertion (79%) and ointment use at insertion site (3%). Prevention measures for catheter maintenance are in accordance with guidelines, except for skin disinfection with at least 0.5% chlorhexidine and 70% alcohol (67% compliance) and regular antiseptic ointment use at the insertion site (3%). Before fistula cannulation, skin preparation is suboptimal; forearm hygiene is performed in only 61% of cases. Several factors explain the low rate of fistulas, including patient preference (69%) and lack of surgical resources (39%; P = .01).
  
  
  CONCLUSIONS
  Improvement in standardization of care according to practice guidelines is necessary. Fistula rate could be increased by improving access to surgical resources and patient education. Strategies are now being elaborated to address these findings.
authors.affiliation: Infection Prevention and Control, Department of Medical Microbiology, Centre Hospitalier Universitaire (CHU) de Québec Pavillon Hôtel-Dieu de Québec, Quebec City, Quebec, Canada.
authors.forename: Pascale
authors.initials: P
authors.lastname: Trépanier
authors.forename: Caroline
authors.initials: C
authors.lastname: Quach
authors.forename: Milagros
authors.initials: M
authors.lastname: Gonzales
authors.forename: Elise
authors.initials: E
authors.lastname: Fortin
authors.forename: Mohammed
authors.initials: M
authors.lastname: Kaouache
authors.forename: Simon
authors.initials: S
authors.lastname: Desmeules
authors.forename: Isabelle
authors.initials: I
authors.lastname: Rocher
authors.forename: Muleka
authors.initials: M
authors.lastname: Ngenda-Muadi
authors.forename: Charles
authors.initials: C
authors.lastname: Frenette
authors.forename: Claude
authors.initials: C
authors.lastname: Tremblay
mesh_terms: D000553:Ambulatory Care; D016470:Bacteremia / Q000517:prevention & control*; D055499:Catheter-Related Infections / Q000517:prevention & control*; D003428:Cross Infection / Q000517:prevention & control*; D019538:Health Care Surveys; D006801:Humans; D017053:Infection Control / Q000379:methods*; D011792:Quebec; D006435:Renal Dialysis / Q000009:adverse effects*; D011795:Surveys and Questionnaires