title: ["Getting to zero infections" in hemodialysis].
abstract: BACKGROUND
  We describe two measures adopted in hemodialysis outpatient population in order to reduce Central Venous Catheter (CVC) related infections. The first is a nurse staff training in the field project and the second deals with the employment of chlorhexidine-impregnated dressing devices. These actions were performed after high infection rates were observed through a dedicated register.
  
  
  METHODS
  In the limited assistance dialysis center, direct observation (12/2012-02/2013) quantified the gap between the observed and expected health care behaviour. Training needs were defined and a 40 hours nurse staff training in the field was performed on two occasions. In the hospital dialysis center, we introduced alcoholic 2% chlorhexidine solution and chlorhexidine-impregnated dressing devices to the exit site (CHG-Tegaderm and BioPatch). Infections (cumulatively bacteremia/sepsis/skin exit/subcutaneous tunnel) were monitored continuously.
  
  
  RESULTS
  Infection rates at the two locations were progressively reduced, reaching a value of zero at the limited assistance center. Nurse staff training in the field produced: two patient reports and three CVC management protocols, Italian language translation of the "The 5 moments of dialysis" WHO poster, alcoholic 2% chlorhexidine adoption to exit-site medication and improvement of environment cleaning/sanitation actions.
  
  
  CONCLUSIONS
  Our experience shows that continuously monitoring infection rates represents the first step for timely corrective action. The continuous updating of health personnel, codified prevention measures and an ongoing commitment to raise awareness in a routine practice, allows us to obtain the goal of "getting to zero infections". The staff training produced equal or superior results compared to the isolated use of new chlorhexidine-impregnated dressing devices.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Leonardi
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Finotto
authors.forename: Marinella
authors.initials: M
authors.lastname: Talaia
authors.forename: Angelo
authors.initials: A
authors.lastname: Nappo
authors.forename: Caterina
authors.initials: C
authors.lastname: Dolla
authors.forename: Maria Cristina
authors.initials: MC
authors.lastname: Di Vico
authors.forename: Davide
authors.initials: D
authors.lastname: Diena
authors.forename: Antonio
authors.initials: A
authors.lastname: Linsalata
authors.forename: Cesare
authors.initials: C
authors.lastname: Guarena
authors.forename: Silvana
authors.initials: S
authors.lastname: Barbaro
authors.forename: Luigi
authors.initials: L
authors.lastname: Biancone
mesh_terms: D000891:Anti-Infective Agents, Local / Q000627:therapeutic use*; D001458:Bandages; D055499:Catheter-Related Infections / Q000517:prevention & control*; D002710:Chlorhexidine / Q000627:therapeutic use*; D004506:Education, Nursing; D006801:Humans; D006435:Renal Dialysis
chemical_list: D000891:Anti-Infective Agents, Local; D002710:Chlorhexidine