Best Practices for Bloodstream Infection Prevention in Dialysis Setting

Key points

  • These recommendations, known as the Core Interventions, are a proven approach to bloodstream infection prevention in outpatient dialysis facilities.
  • CDC resources assist with staff education and implementation of infection prevention and control practices in the dialysis setting.


Bloodstream infections (BSIs) are a dangerous complication of dialysis. Following proper infection prevention and control procedures in the dialysis facility can protect patients. The Core Interventions are an approach to BSI prevention in dialysis facilities and have been proven to reduce dialysis BSIs.

Core Interventions

This information is also available as a downloadable PDF.

  • Conduct monthly surveillance for BSIs and other dialysis events using National Healthcare Safety Network(NHSN)—Dialysis Surveillance. Calculate facility rates and compare to rates in other NHSN facilities. Actively share results with front-line clinical staff.

  • Perform observations of hand hygiene opportunities monthly and share results with clinical staff.

  • Perform observations of vascular access care and catheter accessing quarterly. Assess staff adherence to aseptic technique when connecting and disconnecting catheters and during dressing changes. Share results with clinical staff.

  • Train staff on infection control topics, including access care and aseptic technique.
  • Perform competency evaluation for skills such as catheter care and accessing every 6-12 months and upon hire.

  • Provide standardized education to all patients on infection prevention topics including vascular access care, hand hygiene, risks related to catheter use, recognizing signs of infection, and instructions for access management when away from the dialysis unit.

  • Incorporate efforts (e.g., through patient education, vascular access coordinator) to reduce catheters by identifying and addressing barriers to permanent vascular access placement and catheter removal.

  • Use an alcohol-based chlorhexidine (>0.5%) solution as the first line skin antiseptic agent for central line insertion and during dressing changes.
    • Povidone-iodine (preferably with alcohol) or 70% alcohol are alternatives for patients with chlorhexidine intolerance.

  • Scrub catheter hubs with an appropriate antiseptic after cap is removed and before accessing. Perform every time catheter is accessed or disconnected.
  • If a closed needleless connector device is used, disinfect connector device per manufacturer's instructions.

  • Apply antibiotic ointment or povidone-iodine ointment to catheter exit sites during dressing change. See more informationA on selecting an antimicrobial ointment for hemodialysis catheter exit sites. Use of chlorhexidine-impregnated sponge dressing might be an alternative.

Special considerations

Hemodialysis central venous catheter Scrub-the-Hub protocol

This protocol outlines a suggested approach to preparing catheter hubs prior to accessing the catheter for hemodialysis. It is based on evidence where available and incorporates theoretical rationale when published evidence is unavailable.

Checklists and tools

CDC has checklists and tools to promote proper infection prevention and control practices in dialysis facilities.

Keep Reading: Resources & Tools

Helpful links

  1. CDC recommends using povidone iodine ointment or bacitracin/gramicidin/polymyxin B ointment at the hemodialysis catheter exit site after catheter insertion and at each hemodialysis session. Bacitracin/gramicidin/polymyxin B ointment is not currently available in the United States. Triple antibiotic ointment (bacitracin/neomycin/polymyxin B) is available and might have a similar benefit but studies have not thoroughly evaluated its effect for prevention of bloodstream and exit-site infections. Other ointments that have been studied include single antibiotic ointments (e.g., mupirocin). However, concerns exist about development of antimicrobial resistance and also their ability to cover the spectrum of potential pathogens (e.g., gram-negative and gram-positive bacteria) that can cause bloodstream infections in dialysis patients. Ingredients in antibiotic and povidone-iodine ointments may interact with the chemical composition of certain catheters. Therefore, before any product is applied to the catheter, first check with the catheter manufacturer to ensure that the selected ointment will not interact with the catheter material.