In Reply to ‘Bloodstream Infections in Hemodialysis Patients: The Role of Dialysis Providers’

Abstract

Novosad et al 1 have alerted hemodialysis facilities to the wall boxes as an unsuspected source of Gram-negative bloodstream infections (BSIs), occurring largely in patients with catheter vascular accesses. However, they and the accompanying editorial 2 also stressed deficiencies in infection control techniques, largely gaps in staff hand hygiene, that served to transfer these bacteria to and between patients. During the same 2015 to 2016 period of those findings, our study 3 of BSI rates of patients with and without catheters in all 179 Medicare facilities in New England showed that 4 of the 5 dialysis provider groups had significantly higher BSI rates in their patients with catheters than the best-performing dialysis provider group (adjusted risk ratios of 1.44-1.91; P ≤ 0.001). Because BSI rates in patients without catheters, constituting 80% to 90% of most facilities, were similar among the 5 provider groups, overall reported BSI rates often give a false sense of infection control adequacy. 3 Therefore, if we are to "target zero infections in hemodialysis," 2 each facility should calculate its BSI rate in patients with catheters separately, and if greater than average (w2.15 per 100 patientmonths 3), look for gaps in infection control techniques and retrain dialysis staff to correct deficiencies. 4 However, my attempts to engage the large dialysis provider groups in New England has met with only partial success, although all have joined the Making Dialysis Safer for Patients Coalition. 5 In the interest of dialysis patient safety, some dialysis provider groups need to step up and educate their staff to perform best infection prevention practices regularly.