Dialysis Safety

Healthcare Providers

Overview

Reducing healthcare-associated infections (HAIs) is a national priority. Healthcare providers (HCPs) have made incredible efforts to prevent these infections in intensive care units and other inpatient settings. That same commitment to prevention must be applied in outpatient settings such as dialysis clinics.

In 2008, hemodialysis patients experienced approximately 37,000 central-line associated bloodstream infections (CLABSIs). Within the past 10 years, there have been more than 30 outbreaks of hepatitis B and hepatitis C in non-hospital healthcare settings such as outpatient clinics, dialysis centers, and long-term care facilities. The reduction and ultimate elimination of HAIs in dialysis settings (CLABSIs) requires a partnership between many stakeholders; however, clinicians are ultimately responsible for ensuring every patient receives safe care.

CDC provides a recommended set of interventions to prevent bloodstream infections (BSI) in hemodialysis patients [PDF - 529KB]. These recommendations are already being implemented by a group of dialysis providers in collaboration with CDC. This partnership, known as CDC’s Dialysis BSI Prevention Collaborative, was established to allow facilities to share best- and evidence-based practices to prevent BSIs. Results are measured using CDC’s HAI surveillance system, the National Healthcare Safety Network (NHSN). The Collaboration includes freestanding and hospital-based facilities. Please contact cdcinfo@cdc.gov for more information.

Basic steps clinicians can take to prevent infections in hemodialysis patients include:

Promote fistula use
Get catheters out
Improve catheter care
Clean hands before and after every patient contact
Talk to patients about good vascular access care

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Continuing Education

Infection Prevention in Dialysis Settings for outpatient hemodialysis healthcare workers, including technicians and nurses.

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Guidelines and Recommendations

CDC. Infection Control Requirements for Dialysis Facilities and Clarification Regarding Guidance on Parenteral Medication Vials. MMWR 2008;57(32);875–6.
Siegel JD, Rhinehart E, Jackson M, et al. the Healthcare Infection Control Practices Advisory Committee (HICPAC). Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings, 2007
CDC. Guidelines for Environmental Infection Control in Health-Care Facilities. MMWR 2003; 52(RR10):1–42. [PDF 1.4 MB]
Guidelines for the Prevention of Intravascular Catheter-Related Infections. HICPAC 2011.
CDC. Boyce JM, Pittet D. Healthcare Infection Control Practices Advisory Committee (HICPAC). Guideline for Hand Hygiene in Health-Care Settings [PDF - 496 KB] MMWR 2002;51
Recommendations for Preventing Transmission of Infections Among Chronic Hemodialysis Patients [PDF - 386 KB] MMWR April 27, 2001/50(RR05);1-43

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Clinical Practice Consensus Guidelines

Fingerhut D, Fiorarancio M, Milburn R, et al. National Kidney Foundation -KDOQI. Clinical Practice Guidelines and Clinical Practice Recommendations 2006.
Clinical Practice Guidelines for Peritoneal Dialysis Adequacy Update 2006.
Warady BA. Guidelines for the Treatment of Peritonitis in Children. Perit Dial Int 2000;20:607. [PDF - 458 KB]
Keane WF, Bailie GR, Boeschoten E, et al. ISPD Guidelines/Recommendations: Adult Peritoneal Dialysis-Related Peritonitis Treatment Recommendations: 2000 Update. Perit Dial Int 2000;20(4): 396–411 [PDF - 113 KB]
Gokal R, Alexander S, Ash S, et al. International Society for Peritoneal Dialysis. Peritoneal Catheters and Exit Site Practices Toward Optimum Peritoneal Access: 1998 Update.

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Immunizations

CDC. Guidelines for Vaccinating Kidney Dialysis Patients and Patients with Chronic Kidney Disease. [PDF - 298 KB] ACIP 2006.
STIC: The Safe and Timely Immunization Coalition
This national coalition consisting of healthcare professionals and patients with end stage renal disease (ESRD) was formed in 2005 to increase the rate of hepatitis B, influenza, and pneumococcal immunizations in patients and staff in dialysis settings.
- ESRD Network 6. Safe and Timely Immunization Coalition (STIC): A Comprehensive Resource Guide of Educational Materials on Hepatitis B, Influenza, and Pneumococcal Immunizations.
- ESRD Network 11. Safe and Timely Immunization Coalition (STIC). Resource Guide & Guidelines for Vaccinating Kidney Dialysis Patients and Patients with Chronic Kidney Disease.
- ESRD Network 15. Safe and Timely Immunization Coalition (STIC): Sample QI Project: Improving Immunization Rates.

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