title: Infection prevention and the medical director: uncharted territory.
abstract: Infections continue to be a major cause of disease and contributor to death in patients on dialysis. Despite our knowledge and acceptance that hemodialysis catheters should be avoided and eliminated, most patients who begin dialysis initiate treatment through a central vein hemodialysis catheter. Dialysis Medical Directors must be the instrument through which our industry changes. We must lead the charge to educate our dialysis staff and our dialysis patients. We must also educate ourselves so that we not only know that our facility policies are consistent with the best evidence available, but we must also know where local and federal regulations differ. When these differences impact on patient care, we must speak out and have these regulations changed. But it is not enough to know the rules and write them. We must lead by example and show our patients, our nephrology colleagues and our dialysis staff that we always follow these same policies. We need to practice what we preach and be willing and available to redirect those individuals who have difficulty following the rules. In order to effectively change process meaningful data must be collected, analyzed and acted upon. Dialysis Medical Directors must direct and lead the quality improvement process. We hope this review provides Dialysis Medical Directors with the necessary tools to effectively drive this process and improve care.
authors.affiliation: Associate Professor of Medicine, Rutgers-Robert Wood Johnson Medical School, Department of Medicine, Division of Nephrology New Brunswick, New Jersey; Medical Director, Dialysis Clinic, Inc., North Brunswick, New Jersey;
authors.forename: Toros
authors.initials: T
authors.lastname: Kapoian
authors.affiliation: Professor of Medicine, Division of Nephrology, Tufts University School of Medicine, Medford, Massachusetts; Director, Dialysis Services, Tufts Medical Center, Boston, Massachusetts; and.
authors.forename: Klemens B
authors.initials: KB
authors.lastname: Meyer
authors.affiliation: Vice-Chairman of the Board, Dialysis Clinic Inc., Nashville, Tennessee doug.johnson@dciinc.org.
authors.forename: Douglas S
authors.initials: DS
authors.lastname: Johnson
mesh_terms: D000554:Ambulatory Care Facilities / Q000331:legislation & jurisprudence / Q000592:standards*; D055499:Catheter-Related Infections / Q000517:prevention & control; D004866:Equipment Contamination / Q000517:prevention & control; D063373:Hand Hygiene; D006801:Humans; D017053:Infection Control / Q000379:methods* / Q000592:standards*; D007857:Leadership; D016134:Organizational Policy; D010353:Patient Education as Topic; D008486:Physician Executives; D006435:Renal Dialysis / Q000009:adverse effects / Q000592:standards*; D014611:Vaccination
keywords: chronic dialysis; chronic hemodialysis; dialysis access; immunology; vascular access