Nephrologists Transforming Dialysis Safety

Alan Kliger, MD

Target Zero Infections in Dialysis Patients

NTDS Dialysis Quality and Safety Platform• Identify, Develop, Share Evidence-

Based Knowledge:• Foster learning: staff and patients• Educational conferences & webinars• www.asn-online.org/NTDS

• Improve System Function Using Human Factors Engineering

• Measure and improve the way care is delivered in dialysis facilities

• Promote Effective Leadership • Power of Inspirational Leadership • Commit to eliminate infections• Create psychological safety and empower others• Nephrologists must lead by example

EVIDENCE-BASED KNOWLEDGE

Blood Culture Standardization• A set of standard Recommendations (12) and Rationale

for each Recommendation based on the literature and guidance from professional organizations (CDC, IDSA, CLSI)

• Includes 2 sites from which blood can be accessed, including the catheter hub, the hemodialysis circuit (tubing connected to the catheter hub), and a peripheral vein

• SBAR introductory slide set and template

• A step-by-step blood culture draw procedure

• A competency checklist and recommendations

• https://www.asn-online.org/g/blast/files/NTDS_Blood_Culture_Collection_Standardization_combined_01.16.2020.pdf

Dialysis Care Checklist Pilot• Launch January 2020 for 4-month pilot• 6 dialysis facilities participating: volunteered

by Workgroup members• Goal: Determine feasibility of increasing the

use of CDC chairside checklists to improve infection control practices in outpatient dialysis.

• Pilot was concluded early due to COVID-19; the analysis is in process

Hepatitis C Monitoring and Treatment Algorithm

https://www.asn-online.org/g/blast/files/NCHHSTP_NTDS-HCV%20Subcommittee%20Algorithm_FINAL%2003.29.19.pdf

Recommendations for Preventing the Transmission of C-Difficile Infection (CDI) in Out-Patient Hemodialysis Facilities

• Patients on maintenance hemodialysis are 2-2.5 times more likely to develop CDI with mortality rates 2-fold higher compared to the general population

• Recommendations include:• Infection prevention and control resources/activities which outpatient dialysis facilities

should have in place for the care of CDI• Preferred hand hygiene measures when caring for a patient with suspected or confirmed

CDI• Personal protective equipment which should be worn when caring for a patient with

suspected or confirmed CDI• Preferred treatment placement for patients with CDI• Bathroom facilities and precautions• Length of time to maintain precautions• Optimal measures for environmental disinfection

Educational Materials

• Targeting Zero Infections Webinar Series:

• 7 webinars, with over 3,700 participants

• NephSAP Infection Prevention Special Edition, released July 2019

• Infection Prevention Curriculum

Educational Materials

• Online Learning Module: Managing Infections in an Outpatient Dialysis Facility

• Presents core infection prevention and patient safety concepts in a case-based, interactive format

• https://www.asn-online.org/ntds/olm.aspx

Human Factors Human factors is a scientific discipline that examines human

capabilities and limitations and applies that knowledge to the design of tools, technology, and processes to facilitate safe,

efficient, and effective work.

This Photo by Unknown Author is licensed under CC BY-NC-ND

Human Factors Assessments• Visited 8 US dialysis facilities over the last 18 months• During each site visit, a team of HF engineers from Virginia

Tech/Carilion Clinic, NTDS leadership physicians, and CDC representatives observe clinic operations, conducts focus groups, and uses HF assessment tools to understand the culture of each facility

• In a post visit report, the team provides suggestions to improve operations in the areas of CVC procedures at the onset and conclusion of dialysis, hand hygiene, medication preparation and administration, and disinfection of the dialysis station after the dialysis procedure

Leadership Animatic

Leadership, Education and Culture Change• Kidney Leadership Academy (Pilot with NKC)

oAgenda Personality Types Team Verses Group Leading Your Way to Success: Five Key

Leadership Lessons Essence of Change: Effective Strategies for

Change Management Application of Effective Conflict Management for

Physicians Competing Stakeholders for Dialysis

oSix-month Follow-up oEvaluation

ASN COVID-19 Response Team

Outpatient Dialysis

Inpatient AKI

Home Dialysis

Kidney Transplant

Education• COVID-19 Webpage – www.asn-online.org/covid-19• Awareness posters in English and Spanish• Developed a compendium of Mental Health Resources for staff

and patients• 13 Weekly educational webinars• 10 Peer-Reviewed Publications • Media interviews (PBS Newshour, NYT, Washington Post,

CNBC, Irish Times, ProPublica, Politico, etc.)

Collaboration with CDC and the Community

• CDC Compiled and published recommendations for Information for Screening

and Management of COVID-19 in the Outpatient Dialysis Facility (posted on February 28, with updates on March 4, and March 13) with input and approval from CDC colleagues. Compiled and published Recommendations on the Care of Hospitalized

Patients with COVID-19 and Kidney Failure Requiring Renal Replacement Therapy with input and approval from the CDC. (posted March 21)

• Community• Hosting weekly calls with CMOs from dialysis providers across the country

Advocacy: Some Examples• Outreach to Indian Health Service and the Navajo Nation in response

to the high rate of COVID-19 cases reported on the Navajo reservation in the 4-Corner’s area

• No blanket exclusion of ESKD patients in times of scarce resources: Letter to Secretary Azar

• Joint Letter: ASN and NKF. Acceleration of the production and distribution of PPE for healthcare professionals with vulnerable populations, March 30, 2020

• CMS Waivers