title: Pediatric Fistula Initiative: Reducing Bloodstream Infections in an Outpatient Pediatric Hemodialysis Center.
abstract: Bloodstream infection is a major contributor to morbidity and mortality in children on hemodialysis (HD). From January 2009 through April 2011, the incidence of access-related bloodstream infections (ARBs) in pediatric patients on HD at our hospital was 3.45/1000 patient days. Almost all of these children were receiving HD via central line catheters, and none were receiving HD via arteriovenous fistulas (AVFs). In an effort to reduce the rate of infection in children receiving HD at our institution, we introduced the Pediatric Fistula Initiative, a program to increase creation and use of AVFs in children. Thirty-three children on HD were observed, 9 of whom received AVFs during the study period. The incidence of ARBs decreased to 1.30/1000 patient days (P < .001) during the 24-month intervention period from May 2011 through May 2013.
authors.affiliation: Department of Pediatrics Division of Pediatric Infectious Diseases.
authors.forename: Kobkul
authors.initials: K
authors.lastname: Chotikanatis
authors.affiliation: Department of Pediatrics.
authors.forename: Nisha
authors.initials: N
authors.lastname: Suman
authors.affiliation: Department of Pediatrics Division of Pediatric Infectious Diseases.
authors.forename: Martin
authors.initials: M
authors.lastname: Bäcker
authors.affiliation: Department of Pediatrics Division of Nephrology, Children's Hospital at Downstate, SUNY Downstate Medical Center, Brooklyn, New York.
authors.forename: Bandana
authors.initials: B
authors.lastname: Paudyal
authors.affiliation: Department of Pediatrics Division of Nephrology, Children's Hospital at Downstate, SUNY Downstate Medical Center, Brooklyn, New York.
authors.forename: Morris
authors.initials: M
authors.lastname: Schoeneman
authors.affiliation: Department of Pediatrics Division of Pediatric Infectious Diseases.
authors.forename: Stephan
authors.initials: S
authors.lastname: Kohlhoff
authors.affiliation: Department of Pediatrics Division of Pediatric Infectious Diseases.
authors.forename: Margaret R
authors.initials: MR
authors.lastname: Hammerschlag
mesh_terms: D000293:Adolescent; D001166:Arteriovenous Shunt, Surgical; D016470:Bacteremia / Q000517:prevention & control*; D062905:Central Venous Catheters; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D010045:Outpatients; D006435:Renal Dialysis; D055815:Young Adult
keywords: CRBSIs; Pediatric Fistula Initiative; access-related bloodstream infections; arteriovenous fistulas; catheter-related bloodstream infections; hemodialysis