National Healthcare Safety Network (NHSN) Dialysis Event Surveillance Report for 2014

Nguyen, Duc B.; Shugart, Alicia; Lines, Christi; Shah, Ami B; Edwards, Jonathan R.; Pollock, Daniel A.; Sievert, Dawn M.; Patel, Priti R.

doi:10.2215/cjn.11411116

Cited by 132 publications

(162 citation statements)

References 25 publications

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“…In this study, the overall pooled three events rate was 1.60 per 100 patient‐months. The rate was slightly higher than 1.47 per 100 patient‐months from an earlier study based on tertiary hospitals in China, but it was lower than the figures from previous studies in the United States (4.75 per 100 patient‐months) and Saudi Arabia (3.1 per 100 patient‐months) . Two important issues should be noted when results of this study were compared with studies from other countries.…”

Section: Discussioncontrasting

confidence: 70%

“…Two important issues should be noted when results of this study were compared with studies from other countries. First, the utilization of fistula was much higher in present study (85.3%) than that in studies from the United States (62.8%) and Saudi Arabia (57.7%), as it has been reported that fistula was associated with decreased infections and complications. Second, although oral antimicrobial start was not a dialysis event of NHSN, however, dialysis patients in China often use oral antimicrobial agents with/without prescriptions to treat infections, rather than IV antimicrobial agents .…”

Section: Discussioncontrasting

confidence: 54%

“…Positive blood culture and antimicrobial start within one calendar day after hospitalization were also reported because outpatients with serious infections were usually admitted to hospital in most of the included centers. The “21 day rule” was applied to reduce potential multiply reporting of the same problem …”

Section: Methodsmentioning

confidence: 99%

“…The CVCs accounted for the majority of access‐related infections and fistulas carried the least risk . Although the CVCs were used among only 19% of hemodialysis patients in the United States, they were responsible for 69% of access‐related bloodstream infections (ARBSIs) . In addition to dialysis access‐related infections, hemodialysis patients were also susceptible to other nonaccess‐related infections including respiratory infections, urinary tract infections, and skin/soft tissues infections …”

Section: Introductionmentioning

confidence: 99%

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Prevalence of infections and antimicrobial use among hemodialysis outpatients: A prospective multicenter study

Zhang

et al. 2020

Seminars in Dialysis

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Hemodialysis patients are vulnerable to infectious diseases and frequent receipt of antimicrobial agents. The aim of this study was to describe the prevalence and characteristics of infections and antimicrobials use among hemodialysis outpatients. We utilized the dialysis event surveillance protocol developed by the National Healthcare Safety Network to conduct a prospective multicenter study in Anhui, China. A total of 41 dialysis centers involving 7393 outpatients were included. Fistula was the most common type of vascular access (85.3%), followed by tunneled central line (12.7%), and non‐tunneled central line (1.2%). There were 118 dialysis events with an overall pooled events rate of 1.60 per 100 patient‐months. Intravenous antimicrobial start, positive blood culture, and pus, redness, or increased swelling at the vascular access site were detected at rates of 0.91, 0.23, and 0.46 per 100 patient‐months, respectively. The prevalence of dialysis events was commonly higher in patients with a central line, and lower in patients with a fistula. Hemodialysis outpatients also had the noteworthy risks of nonaccess infections. Older age, female gender, and having a central line were associated with the increased risk of dialysis events. Findings recommend that regular monitoring and improvement strategies are warranted in management of infections among hemodialysis outpatients.

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Section: Discussioncontrasting

confidence: 70%

Section: Discussioncontrasting

confidence: 54%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Prevalence of infections and antimicrobial use among hemodialysis outpatients: A prospective multicenter study

Zhang

et al. 2020

Seminars in Dialysis

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“…However, these efforts have not translated into sustained improvement at the operational level. Legislated infection control measures, like the National Healthcare Safety Network, have created controversy about facility under-reporting and data integrity, obfuscating discussion about the real goal of a large-scale, systematic, and process-driven infection control program in the United States to support local and regional efforts (25,26).…”

Section: The Importance Of Strategic Leadership and Alignmentmentioning

confidence: 99%

Systems Thinking and Leadership

Wong

2018

CJASN

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Infections are the second leading cause of death for patients with ESKD. Despite multiple efforts, nephrologists have been unable to prevent infections in dialysis facilities. The American Society of Nephrology and the Centers for Disease Control and Prevention have partnered to create Nephrologists Transforming Dialysis Safety to promote nephrologist leadership and engagement in efforts to "Target Zero" preventable dialysis infections. Because traditional approaches to infection control and prevention in dialysis facilities have had limited success, Nephrologists Transforming Dialysis Safety is reconceptualizing the problem in the context of the complexity of health care systems and organizational behavior. By identifying different parts of a problem and attempting to understand how these parts interact and produce a result, systems thinking has effectively tackled difficult problems in dynamic settings. The dialysis facility is composed of different physical and human elements that are interconnected and affect not only behavior but also, the existence of a culture of safety that promotes infection prevention. Because dialysis infections result from a complex system of interactions between caregivers, patients, dialysis organizations, and the environment, attempts to address infections by focusing on one element in isolation often fail. Creating a sense of urgency and commitment to eradicating dialysis infections requires leadership and motivational skills. These skills are not taught in the standard nephrology or medical director curriculum. Effective leadership by medical directors and engagement in infection prevention by nephrologists are required to create a culture of safety. It is imperative that nephrologists commit to leadership training and embrace their potential as change agents to prevent infections in dialysis facilities. This paper explores the systemic factors contributing to the ongoing dialysis infection crisis in the United States and the role of nephrologists in instilling a culture of safety in which infections can be anticipated and prevented.

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Arteriovenous Access for Hemodialysis

Lok,

Huber,

Orchanian-Cheff

et al. 2024

JAMA

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ImportanceHemodialysis requires reliable vascular access to the patient’s blood circulation, such as an arteriovenous access in the form of an autogenous arteriovenous fistula or nonautogenous arteriovenous graft. This Review addresses key issues associated with the construction and maintenance of hemodialysis arteriovenous access.ObservationsAll patients with kidney failure should have an individualized strategy (known as Patient Life-Plan, Access Needs, or PLAN) for kidney replacement therapy and dialysis access, including contingency plans for access failure. Patients should be referred for hemodialysis access when their estimated glomerular filtration rate progressively decreases to 15 to 20 mL/min, or when their peritoneal dialysis, kidney transplant, or current vascular access is failing. Patients with chronic kidney disease should limit or avoid vascular procedures that may complicate future arteriovenous access, such as antecubital venipuncture or peripheral insertion of central catheters. Autogenous arteriovenous fistulas require 3 to 6 months to mature, whereas standard arteriovenous grafts can be used 2 to 4 weeks after being established, and “early-cannulation” grafts can be used within 24 to 72 hours of creation. The prime pathologic lesion of flow-related complications of arteriovenous access is intimal hyperplasia within the arteriovenous access that can lead to stenosis, maturation failure (33%-62% at 6 months), or poor patency (60%-63% at 2 years) and suboptimal dialysis. Nonflow complications such as access-related hand ischemia (“steal syndrome”; 1%-8% of patients) and arteriovenous access infection require timely identification and treatment. An arteriovenous access at high risk of hemorrhaging is a surgical emergency.Conclusions and RelevanceThe selection, creation, and maintenance of arteriovenous access for hemodialysis vascular access is critical for patients with kidney failure. Generalist clinicians play an important role in protecting current and future arteriovenous access; identifying arteriovenous access complications such as infection, steal syndrome, and high-output cardiac failure; and making timely referrals to facilitate arteriovenous access creation and treatment of arteriovenous access complications.

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National Healthcare Safety Network (NHSN) Dialysis Event Surveillance Report for 2014

Cited by 132 publications

References 25 publications

Prevalence of infections and antimicrobial use among hemodialysis outpatients: A prospective multicenter study

Prevalence of infections and antimicrobial use among hemodialysis outpatients: A prospective multicenter study

Systems Thinking and Leadership

Arteriovenous Access for Hemodialysis

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