Frequently Asked Questions About Dialysis Event Reporting

Can my dialysis clinic/unit/facility use NHSN for dialysis event surveillance?

The surveillance population for this module is “chronic hemodialysis outpatients” (i.e., patients who receive maintenance hemodialysis). If you have a hospital-based unit that cares for inpatients in addition to outpatients, you can participate as long as you have the ability to separate out your inpatients from your outpatients for the purpose of reporting (for both events/numerator and census/denominator data).

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Does the dialysis event surveillance population include pediatric patients?

Yes, include all hemodialysis outpatients in dialysis event surveillance, including pediatric patients. Date of birth is a required event field, so age is captured for each dialysis event.

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Does the dialysis event surveillance population include peritoneal dialysis patients?

No, the dialysis event surveillance population includes only maintenance hemodialysis outpatients.

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If a dialysis patient has a bloodstream infection and then is admitted to an inpatient facility for treatment, will the bloodstream infection be “double-counted?”

If a dialysis outpatient met the criteria for an NHSN Dialysis Event and then was admitted, the inpatient facility would not report the BSI, because per the NHSN CLABSI Protocol Cdc-pdf[PDF – 169 KB], inpatient facilities are instructed to exclude Central Line Associated Bloodstream Infections (CLABSIs) that are present or incubating at the time of admission.

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How was the Dialysis Event Protocol designed, and what is the end goal?

The surveillance protocol is designed to capture data reliably, while striving to balance low data collection burden with high data validity to the best extent possible. Large scale surveillance activities will not perfectly capture all desired data completely, nor will captured data be without error. However, the purpose of surveillance is to collect data uniformly so that meaningful comparisons can be made. The only way this can be accomplished is if all surveillance users follow the Dialysis Event Protocol Cdc-pdf[PDF – 342 KB]. Surveillance data needs to be interpreted with an understanding of its limitations in order to make useful conclusions. The goal is not to collect perfectly complete and accurate data (which would have a prohibitive time burden), but rather to generate data that is useful for informing quality improvement decisions.

Surveillance protocols and definitions are continually evaluated and refined to provide the best validity and lowest error rate possible.

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A patient’s central venous catheter is not used for hemodialysis; do I still include it in dialysis event reporting?

Yes, all central venous catheters are included for the purposes of dialysis event reporting, regardless of whether they are currently in use for hemodialysis, or any other treatment.

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When do I complete a Dialysis Event form?

A dialysis event form is completed for any or a combination of the following event types:

  1. IV antimicrobial starts
  2. Positive blood cultures
  3. All new episodes of pus, greater than expected redness, or greater than expected swelling at a vascular access site

Please refer to the protocol and tables of instructions for detailed definitions.

If the patient experiences problems/outcomes collected on the event form (e.g., fever, chills or rigors, hospitalization, death, etc.) but did not experience at least one of the three dialysis events described above, then do not report a dialysis event.

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The vascular access site has some suspicious redness, but the patient does not receive antibiotic treatment, is the redness reportable?

If you would describe the redness as “suspicious” for infection or if it is greater than would be expected, report it regardless of whether or not the patient receives treatment.

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When is pus, redness, or increased swelling at the vascular access site reported?

The presence of pus is always reportable. Report this as a dialysis event only if the redness or swelling at the vascular access site is more than would be expected.  Report even when the patient receives no treatment for the symptom(s).

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The patient currently lives in a long-term care facility and blood cultures were drawn at that location. The blood culture is positive: does this meet the criteria of ‘specimen collected as an outpatient’?

Yes, for the purposes of Dialysis Event reporting, a long-term care facility, skilled nursing facility, or nursing home is considered an outpatient facility so any blood cultures collected in this setting are reportable. Note: a long-term care facility is different from a long-term acute care facility, which is an inpatient setting, and is treated just like a hospital admission.

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How do I know what the suspected source of a positive blood culture is?

There are four types of suspected sources of positive blood cultures in dialysis event surveillance: the vascular access, a source other than the vascular access, contamination, or uncertain. Rules for attributing the positive blood culture to any of these possible sources are outlined in the Dialysis Event Protocol Cdc-pdf[PDF – 342 KB] and Table 9 Cdc-pdf[PDF – 1.4 MB] Dialysis Event Form instructions, in the Patient Safety Manual Tables of Instructions.

We recommend getting an opinion from a physician, head nurse, or infection preventionist if the suspected source of a positive blood culture is unclear.

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A patient’s blood culture is positive for a common skin organism; does that mean the suspected source of the positive blood culture is contamination?

Not necessarily; it is not possible to ascertain the source of a positive blood culture based on organism type alone. Sometimes a common skin organism is a contaminant, but sometimes it is the cause of an infection. We recommend getting an opinion from a physician, head nurse, or infection preventionist if a suspected source of a positive blood culture is unclear.

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Where can I find the meanings of antimicrobial acronyms/abbreviations used for susceptibility results of positive blood cultures?

Meanings of all antimicrobial acronyms/abbreviations are listed on the bottom of page 3 of the Dialysis Event form.

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Are wound cultures reported for dialysis event surveillance?

No, wound cultures are not reportable for dialysis event surveillance. A wound might be the suspected source of a positive blood culture and indicated as “source other than the vascular access,” and the presence of a wound with pus or redness is indicated under the “Problems” section of the Dialysis Event form, but wound culture information is not reported.

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Are oral (p.o.) antimicrobials reported for dialysis event surveillance?

No, oral antimicrobials are not reportable for dialysis event surveillance.  Report only outpatient IV antimicrobial starts. Report all IV antimicrobial starts regardless of the reason for the treatment. This includes outpatient starts that are continuations of inpatient treatment.

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Do surgical revisions of vascular accesses change access placement date?

No, report the date the vascular access was first placed. Do not report dates of surgical revisions.

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