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, the Centers for Disease Control and Prevention (CDC) released results of its Dialysis Bloodstream Infection Prevention Collaborative showing a 32 percent decrease in overall bloodstream infections and a 54 percent decrease in vascular access-related bloodstream infections after CDC prevention guidelines were used. Vascular access-related bloodstream infections are those related to devices used to access the bloodstream for hemodialysis. With approximately 37,000 bloodstream infections occurring each year among dialysis patients with central lines, at an estimated cost of $23,000 per hospitalization, wider implementation of the practices in this study could help save lives and reduce excess health care spending."

Background:  Bloodstream infections (BSIs) cause substantial morbidity in hemodialysis patients. In 2009, the US Centers for Disease Control and Prevention (CDC) sponsored a collaborative project to prevent BSIs in outpatient hemodialysis facilities. We sought to assess the impact of a set of interventions on BSI and access-related BSI rates in participating facilities using data reported to the CDC’s National Healthcare Safety Network (NHSN).

Study Design: Quality improvement project.

Setting & Participants: Patients in 17 outpatient hemodialysis facilities that volunteered to participate.

Quality Improvement Plan: Facilities reported monthly event and denominator data to NHSN, received guidance from the CDC, and implemented an evidence-based intervention package that included chlorhexidine use for catheter exit-site care, staff training and competency assessments focused on catheter care and aseptic technique, hand hygiene and vascular access care audits, and feedback  of infection and adherence rates to staff.

Outcomes: Crude and modeled BSI and access-related BSI rates.

Measurements: Up to 12 months of preintervention (January 2009 through December 2009) and 15 months of intervention period (January 2010 through March 2011) data from participating centers were analyzed. Segmented regression analysis was used to assess changes in BSI and access-related BSI rates during the preintervention and intervention periods.

Results: Most (65%) participating facilities were hospital based. Pooled mean BSI and access-related BSI rates were 1.09 and 0.73 events per 100 patient-months during the preintervention period and 0.89 and 0.42 events per 100 patient-months during the intervention period, respectively. Modeled rates decreased 32% (P =0.01) for BSIs and 54% (P < 0.001) for access-related BSIs at the start of the intervention period.

Limitations: Participating facilities were not representative of all outpatient hemodialysis centers nationally. There was no control arm to this quality improvement project.

Conclusions: Facilities participating in a collaborative successfully decreased their BSI and access-related BSI rates. The decreased rates appeared to be maintained in the intervention period.  These findings suggest that improved implementation of recommended practices can reduce BSIs in hemodialysis centers.