Reduction in Bloodstream Infection Rates in Outpatient Hemodialysis Centers Participating in a CDC Prevention Collaborative
Sarah H. Yi, Alexander J. Kallen, John A. Jernigan, Priti R. Patel for the members of the CDC Dialysis BSI Prevention Collaborative
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, GA USA
Bloodstream infections (BSIs) cause substantial morbidity in hemodialysis patients. We sought to assess the impact of specific interventions on BSI and access-related BSI (ARB) rates in outpatient hemodialysis centers. In 2009, 21 outpatient hemodialysis centers joined a CDC-sponsored collaborative project to prevent BSIs. Centers reported monthly event and denominator data to CDC’s National Healthcare Safety Network, received guidance from CDC, and implemented an evidenced-based intervention package that included: chlorhexidine use for catheter exit site care, application of antimicrobial ointment to exit sites, hand hygiene and vascular access care audits, and feedback of rates to staff. Up to twelve months of pre-intervention (1/2009 – 12/2009) and 15 months of post-intervention (1/2010 – 3/2011) data from 17 participating centers were analyzed. Segmented regression analysis was used to assess changes in BSI and ARB rates during the pre-intervention, intervention implementation, and post-intervention periods. Pooled BSI and ARB rates were 1.09 and 0.73 per 100 patient-months during the pre-intervention period, and 0.89 and 0.42 per 100 patient-months during the post-intervention period, respectively. Modeled rates decreased 31% (p=.015) for BSI and 53% (p<.0001) for ARB during intervention implementation. These decreases appeared to be maintained in the post-intervention period. Collaborative centers successfully decreased their BSI and ARB rates. These findings suggest that improved implementation of evidence-based practices can reduce BSIs in hemodialysis centers.
For more information go to author interview: Sarah Yi, PhD