Press Release

November 1, 2002
Contact: CDC Media Relations
404-639-3286

CDC Promotes Campaign to Prevent Antimicrobial Resistance in Dialysis Patients

The Centers for Disease Control and Prevention (CDC) announced today, during the American Society of Nephrology conference, a campaign aimed at nephrologists to prevent antimicrobial resistance in dialysis patients.

Like the overall campaign to reduce antimicrobial resistance in healthcare settings, launched in March 2002, the component targeting nephrologists centers around four key strategies for preventing antimicrobial resistance in healthcare settings: 1) preventing infection, 2) diagnosing and treating infection effectively, 3) using antimicrobials wisely, and 4) preventing transmission of drug-resistant pathogens. Within these strategies are 12 specific action steps derived from evidenced-based guidelines and recommendations already developed by CDC and other organizations that clinicians can take now to prevent antimicrobial resistance in dialysis patients.

"Due to frequent hospitalizations, receipt of antibiotics, and exposure to bacterial infections at the vascular access site, dialysis patients have an ongoing risk for antimicrobial resistance," said Dr. Steve Solomon, director of CDC's healthcare quality promotion program. This campaign gives nephrologists 12 steps to protect their patients from this ongoing risk."

The action steps for nephrologists who provide care for dialysis patients include:

Action Step 1: Vaccinate Staff and Patients

• Get influenza vaccine
• Give influenza and pneumococcal vaccine to patients in addition to routine vaccines (e.g. hepatitis B)

Action Step 2: Get the Catheters Out
Hemodialysis

• Use catheters only when essential
• Maximize use of fistulas/grafts
• Remove catheters when they are no longer essential

Peritoneal Dialysis

• Remove/replace infected catheters

Action Step 3: Optimize Access Care

• Follow established KDOQI and CDC Guidelines for access care
• Use proper insertion and catheter-care protocols
• Remove access device when infected
• Use the correct catheter

Action Step 4: Target the Pathogen

• Obtain appropriate cultures
• Target empiric therapy to likely pathogens
• Target definitive therapy to known pathogens
• Optimize timing, regimen, dose, route, and duration

Action Step 5: Access the Experts

• Consult the appropriate expert for complicated infections

Action Step 6: Use Local Data

• Know your local antibiogram
• Get previous microbiology results when patients transfer to your facility

Action Step 7: Know When to Say "No" to Vanco

• Follow CDC guidelines for vancomycin use
• Consider 1st generation cephalosporins instead of vancomycin

Action Step 8: Treat Infection, Not Contamination or Colonization

• Use proper antisepsis for drawing blood cultures
• Get one peripheral vein blood culture, if possible
• Avoid culturing vascular catheter tips
• Treat bacteremia, not the catheter tip

Action Step 9: Stop Antimicrobial Treatment

• When infection is treated
• When infection is not diagnosed

Action Step 10: Follow Infection Control Precautions

• Use standard infection control precautions for dialysis centers
• Consult local infection control experts

Action Step 11: Practice Hand Hygiene

• Wash your hands or use an alcohol-based handrub
• Set an example

Action Step 12: Partner With Your Patients

• Educate on access care and infection control measures
• Re-educate regularly

Some of the materials being developed include a slide set featuring the 12 action steps and the evidence to support them, posters, as well as a badge cards listing the 12 action steps. The campaign also features a website where nephrologist may access the 12 action steps as well as information to share with their patients.

Antimicrobial resistant infections in healthcare settings are a major threat to patient safety. Each year in the United States an estimated 2 million hospitalized people acquire infections that result in more 90,000 deaths. More than half of these infections are caused by bacteria that are resistant to at least one of the antimicrobials commonly used to treat those infections, according to CDC.

"CDC believes that this educational campaign can increase patient safety by preventing life-threatening antibiotic resistant infections," said Solomon. "In the future, CDC will announce similar action steps for clinicians who care for surgical patients, patients in long-term care facilities, and hospitalized children."

This campaign is made possible through support from the CDC Foundation http://www.cdcfoundation.org/. For more information on CDC's campaign to prevent antimicrobial resistance in healthcare settings go to www.cdc.gov/drugresistance/healthcare.

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