title: Variation in infection prevention practices in dialysis facilities: results from the national opportunity to improve infection control in ESRD (End-Stage Renal Disease) project.
abstract: OBJECTIVE To observe patient care across hemodialysis facilities enrolled in the National Opportunity to Improve Infection Control in ESRD (end-stage renal disease) (NOTICE) project in order to evaluate adherence to evidence-based practices aimed at prevention of infection. SETTING AND PARTICIPANTS Thirty-four hemodialysis facilities were randomly selected from among 772 facilities in 4 end-stage renal disease participating networks. Facility selection was stratified on dialysis organization affiliation, size, socioeconomic status, and urban/rural status. MEASUREMENTS Trained infection control evaluators used an infection control worksheet to observe 73 distinct infection control practices at the hemodialysis facilities, from October 1, 2011, through January 31, 2012. RESULTS There was considerable variation in infection control practices across enrolled facilities. Overall adherence to recommended practices was 68% (range, 45%-92%) across all facilities. Overall adherence to expected hand hygiene practice was 72% (range, 10%-100%). Compliance to hand hygiene before and after procedures was high; however, during procedures hand hygiene compliance averaged 58%. Use of chlorhexidine as the specific agent for exit site care was 19% overall but varied from 0% to 35% by facility type. The 8 checklists varied in the frequency of perfect performance from 0% for meeting every item on the checklist for disinfection practices to 22% on the arteriovenous access practices at initiation. CONCLUSIONS Our findings suggest that there are many areas for improvement in hand hygiene and other infection prevention practices in end-stage renal disease. These NOTICE project findings will help inform the development of a larger quality improvement initiative at dialysis facilities.
authors.affiliation: 1University of Michigan,Ann Arbor,Michigan.
authors.forename: Carol E
authors.initials: CE
authors.lastname: Chenoweth
authors.affiliation: 2Health Research and Educational Trust,Chicago,Illinois.
authors.forename: Stephen C
authors.initials: SC
authors.lastname: Hines
authors.affiliation: 3Agency for Healthcare Research and Quality,Rockville,Maryland.
authors.forename: Kendall K
authors.initials: KK
authors.lastname: Hall
authors.affiliation: 1University of Michigan,Ann Arbor,Michigan.
authors.forename: Rajiv
authors.initials: R
authors.lastname: Saran
authors.affiliation: 1University of Michigan,Ann Arbor,Michigan.
authors.forename: John D
authors.initials: JD
authors.lastname: Kalbfleisch
authors.affiliation: 4TB Spencer Consulting,Fallbrook,California.
authors.forename: Teri
authors.initials: T
authors.lastname: Spencer
authors.affiliation: 5Centers for Medicaid and Medicare Services,Waterloo,Iowa.
authors.forename: Kelly M
authors.initials: KM
authors.lastname: Frank
authors.affiliation: 6Renal Network of the Upper Midwest,St. Paul,Minnesota.
authors.forename: Diane
authors.initials: D
authors.lastname: Carlson
authors.affiliation: 6Renal Network of the Upper Midwest,St. Paul,Minnesota.
authors.forename: Jan
authors.initials: J
authors.lastname: Deane
authors.affiliation: 1University of Michigan,Ann Arbor,Michigan.
authors.forename: Erik
authors.initials: E
authors.lastname: Roys
authors.affiliation: 1University of Michigan,Ann Arbor,Michigan.
authors.forename: Natalie
authors.initials: N
authors.lastname: Scholz
authors.affiliation: 1University of Michigan,Ann Arbor,Michigan.
authors.forename: Casey
authors.initials: C
authors.lastname: Parrotte
authors.affiliation: 1University of Michigan,Ann Arbor,Michigan.
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Messana
mesh_terms: D000554:Ambulatory Care Facilities / Q000592:standards / Q000706:statistics & numerical data*; D000891:Anti-Infective Agents, Local / Q000627:therapeutic use; D002710:Chlorhexidine / Q000627:therapeutic use; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D063373:Hand Hygiene / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D017053:Infection Control / Q000379:methods* / Q000592:standards / Q000706:statistics & numerical data; D007676:Kidney Failure, Chronic / Q000628:therapy; D017410:Practice Guidelines as Topic; D017064:Process Assessment, Health Care; D058996:Quality Improvement; D006435:Renal Dialysis / Q000592:standards / Q000706:statistics & numerical data*
chemical_list: D000891:Anti-Infective Agents, Local; D002710:Chlorhexidine