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?
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 systems Frequent hospital stays and surgery
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
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!
OutcomePredictor% 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% NHSN Bacteremia -Dressing 1b7 -Injection port 2a9 50% 54% NHSN VAI -Hand hygiene --Injection port 2a9 51% 43%
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
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
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
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!
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
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
Karen Strott, RN Quality Improvement Director Linda Pleiman, RN Quality Improvement Coordinator Lori Chase QI Data Specialist