• Priti R Patel, Sarah H Yi, Stephanie Booth, Virginia Bren, Gemma Downham, Sally Hess, Karen Kelley, Mary Lincoln, Kathy Morrissette, Curt Lindberg, John A Jernigan, and Alexander J Kallen.
• Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. ppatel@cdc.gov
• Am. J. Kidney Dis. 2013 Aug 1;62(2):322-30.

BackgroundBloodstream 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 DesignQuality improvement project.Setting & ParticipantsPatients in 17 outpatient hemodialysis facilities that volunteered to participate.Quality Improvement PlanFacilities 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.OutcomesCrude and modeled BSI and access-related BSI rates.MeasurementsUp 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.ResultsMost (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.LimitationsParticipating facilities were not representative of all outpatient hemodialysis centers nationally. There was no control arm to this quality improvement project.ConclusionsFacilities 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.Published by Elsevier Inc. on behalf of the National Kidney Foundation, Inc.

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