Download Why are dialysis patients at Risk for Infection?

!
Intermountain ESRD – Network 15
Karen Strott, RN
Linda Pleiman, RN
 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!
Outcome
Predictor
% Increase
in Risk**
P-value
-Overall hand hygiene*
-Hand Hygiene After
-Supplies 1c2
-Insert Needle 1c8
-Injection port 2a9
80%
79%
60%
46%
49%
0.016
0.005
0.005
0.042
0.007
NHSN
Bacteremia
-Dressing 1b7
-Injection port 2a9
50%
54%
0.024
0.007
NHSN VAI
-Hand hygiene --Injection
port 2a9
51%
43%
0.001
0.023
ICD-9 HD VAR
Infection Rates
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
CDC Guidance
http://www.cdc.gov/
dialysis/collaborative/
Tools website:
 http://www.cdc.gov/di
alysis/preventiontools/index.html
 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
303.831.8818
[email protected]
Lori Chase
QI Data Specialist
303.831.8818
[email protected]
Linda Pleiman, RN
Quality Improvement
Coordinator
303.831.8818
[email protected]