Bloodstream Infection Rates in Outpatient Hemodialysis Facilities Participating in a Collaborative Prevention Effort: A Quality Improvement Report

Patel, Priti R.; Yi, Sarah H; Booth, Stephanie; Bren, Virginia; Downham, Gemma; Hess, Sally; Kelley, Karen; Lincoln, Mary; Morrissette, Kathy; Lindberg, Curt; Jernigan, John A.; Kallen, Alexander J.

doi:10.1053/j.ajkd.2013.03.011

Cited by 99 publications

(93 citation statements)

References 13 publications

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“…These measures include the use of chlorhexidine skin antisepsis at the catheter exit site, catheter hub disinfection, and the application of triple antibiotic (or povidone iodine) ointment to catheter exit sites during dressing changes. Similar "bundled" care efforts in intensive care units have shown dramatic decreases in nondialysis CRBSI rates (8,9). The CDC Dialysis Collaborative used a comprehensive dialysis catheter management protocol in 17 outpatient dialysis units and found a 54% reduction (P,0.001) in CRBSI during the 15-month intervention period (10).…”

mentioning

confidence: 98%

Reducing Catheter-Related Infections in Hemodialysis Patients

Landry

Braden

2014

Clinical Journal of the American Society of Nephrology

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confidence: 98%

Reducing Catheter-Related Infections in Hemodialysis Patients

Landry

Braden

2014

Clinical Journal of the American Society of Nephrology

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“…The implementation of these key interventions or select elements thereof in a bundled approach has been shown to reduce CLABSI rates by 21-100% [5,26,27] .…”

Section: Bundlesmentioning

confidence: 99%

“…In 2002, it was estimated that 50,000 CLABSIs occur in dialysis patients in the US annually. A more recent surveillance study found the rate of access-related BSIs to be 0.73 events per 100 patient-months [5] . Aside from catheters, patients in need of renal replacement therapy should eventually use arteriovenous fistula (AVF) or arteriovenous grafts (AVG) for HD, or alternatively, may receive peritoneal dialysis.…”

Section: Introductionmentioning

confidence: 99%

Nosocomial Infections in Dialysis Access

Schweiger

Trevino²,

Marschall³

2015

Contributions to Nephrology

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Nosocomial infections in patients requiring renal replacement therapy have a high impact on morbidity and mortality. The most dangerous complication is bloodstream infection (BSI) associated with the vascular access, with a low BSI risk in arteriovenous fistulas or grafts and a comparatively high risk in central venous catheters. The single most important measure for preventing BSI is therefore the reduction of catheter use by means of early fistula formation. As this is not always feasible, prevention should focus on educational efforts, hand hygiene, surveillance of dialysis-associated events, and specific measures at and after the insertion of catheters. Core measures at the time of insertion include choosing the optimal site of insertion, the use of maximum sterile barrier precautions, adequate skin antisepsis, and the choice of catheter type; after insertion, access care needs to ensure hub disinfection and regular dressing changes. The application of antimicrobial locks is reserved for special situations. Evidence suggests that bundling a selection of the aforementioned measures can significantly reduce infection rates. The diagnosis of central lineassociated BSI (CLABSI) is based on clinical signs and microbiological findings in blood cultures ideally drawn both peripherally and from the catheter. The prompt installation of empiric antibiotic treatment covering the most commonly encountered organisms is key regarding CLABSI treatment. Catheter removal is recommended in complicated cases or if cultures yield Staphylococcus aureus , enterococci, Pseudomonas or fungi. In other cases, guide wire exchange or catheter salvage strategies with antibiotic lock solutions may be acceptable alternatives.

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“…They also tend to be elderly, and controlling the antibiotic dose is important [1,2]. HD patients are also at high risk for blood stream-related infections [3] and methicillin-resistant Staphylococcus aureus or drug-resistant bacterial infections [4].…”

Section: Introductionmentioning

confidence: 99%

Modified A-DROP score and mortality in hemodialysis patients with pneumonia

et al. 2017

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Background: Pneumonia is common in hemodialysis (HD) patients and has a poor prognosis, but there is little information on an accurate method for evaluating the severity of pneumonia, which is closely associated with prognosis, in HD patients. This study examined a method for evaluating the severity of pneumonia that was closely associated with 30-day mortality in HD patients. Methods: This was a retrospective observational study of 64 HD patients. We determined the relationship between the severity of pneumonia using a modified A-DROP (excluding the dehydration section) score and 30-day mortality. Results: Nine patients (14.1%) died and 40% of patients with an A-DROP score of 3 or 4 died within 30 days. Logistic regression analysis showed that the A-DROP score was significantly associated with 30-day mortality. The discriminatory ability of the A-DROP score was assessed using area under the receiver operating characteristic curve analysis (0.810; 95% confidence interval 0.653-0.967; p < 0.01).Conclusions: This modified A-DROP scoring system reflected the severity of pneumonia and was significantly associated with 30-day mortality. Patients with a modified A-DROP score of 3 or 4 had a poor prognosis.

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Bloodstream Infection Rates in Outpatient Hemodialysis Facilities Participating in a Collaborative Prevention Effort: A Quality Improvement Report

Cited by 99 publications

References 13 publications

Reducing Catheter-Related Infections in Hemodialysis Patients

Reducing Catheter-Related Infections in Hemodialysis Patients

Nosocomial Infections in Dialysis Access

Modified A-DROP score and mortality in hemodialysis patients with pneumonia

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