CDC RESOURCES TO HELP REDUCE

DIALYSIS RELATED INFECTIONS

Intermountain ESRD – Network 15

Karen Strott, RN

Linda Pleiman, RN

!

OBJECTIVES

Identify 5 evidence based resources proven to reduce HAI’s in the dialysis setting

Review how to implement the use of audits in your QAPI program

Review Wyoming infection data-How does your dialysis unit stack up?

WHY ARE DIALYSIS PATIENTS AT RISK FOR INFECTION?

Patients who undergo hemodialysis have a higher risk of infection, due to the following factors:

Frequent use of catheters or insertion of needles to access the bloodstream

Weakened immune systemsFrequent hospital stays and surgery

WHY? About 410,000 people receive

hemodialysis (HD) at any given time in the United States

About 8 in 10 of these patients start treatment through a central line (a major risk factor for BSI)

Infections are one of the leading causes of hospitalization and death for patients on hemodialysis

WHY?

For hemodialysis patients, the rate of infection is now 43% greater than it was in 1993!

Hospitalization rates for BSIs have increased by 47% and by 87% for vascular access infections!

WHAT PUTS PATIENTS AT RISK?NOTICE PROJECT 2011

Outcome Predictor % Increase in Risk**

P-value

ICD-9 HD VAR Infection Rates

-Overall hand hygiene* -Hand Hygiene After -Supplies 1c2-Insert Needle 1c8-Injection port 2a9

80%79%60%46%49%

0.0160.0050.0050.0420.007

NHSN Bacteremia

-Dressing 1b7-Injection port 2a9

50%54%

0.0240.007

NHSN VAI -Hand hygiene --Injection port 2a9

51%43%

0.0010.023

WHAT DO WE NEED TO DO?

CLABSI prevention in dialysis facilities will require: Increased adherence to current inpatient CLABSI prevention recommendations

The development and implementation of additional prevention strategies specific to the dialysis environment

Collection and analysis of data

CDC Guidance

http://www.cdc.gov/dialysis/collaborative/

Tools website: http://www.cdc.gov/

dialysis/prevention-tools/index.html

CDC CORE INTERVENTIONS

Surveillance and feedback using NHSN Hand hygiene observations Catheter/vascular access observations Staff education and competency Patient education/engagement Catheter reduction Chlorhexidine for skin asepsis Catheter hub disinfection Antimicrobial ointment

HAND HYGIENE OBSERVATIONS

CATHETER CARE

Use chlorhexidine for skin antisepsis during insertion/dressing change (allow to dry)

Catheter hub cleansing (scrub-the-hub) after cap removed and before accessing

Use antimicrobial ointment or chlorhexidine-impregnated sponge dressings

VASCULAR ACCESS CARE

KEY INFECTION PREVENTION PRACTICES

Perform hand hygiene frequently/change gloves

Maintain separate clean areas for supplies and medications and separate contaminated areas for used items

Practice safe injection practices Perform proper environmental cleaning Dedicate supplies to a single patient

Use aseptic technique every time!

USING AUDITS IN QAPI

Perform audits on a regular basis Involve all staff in audit process Share results with staff Review audit findings monthly in QAPI Use results to identify areas for

improvement Perform follow up audits of problem staff

or areas identified for improvement Review and celebrate improvements

USE NHSN

Know your data Share your data Compare your data to other facilities Use your data to improve outcomes Use NHSN to improve communication

between patients, staff and other facilities

REVIEW WYOMING INFECTION DATA-HOW DOES YOUR DIALYSIS

UNIT STACK UP?

CONTACTINGNETWORK 15

Karen Strott, RNQuality Improvement

Director303.831.8818

kstrott@nw15.esrd.net

Linda Pleiman, RNQuality Improvement

Coordinator303.831.8818

lpleiman@nw15.esrd.net

Lori ChaseQI Data Specialist

303.831.8818lchase@nw15.esrd.net