Preventing Bloodstream Infections in Hemodialysis Patients

Bloodstream Infections (BSI) are dangerous complications and leading cause of death in hemodialysis patients.  This webpage provides resources and guidance to California health care personnel and the dialysis community, infection prevention guidelines and recommendations, clinician and patient education, hemodialysis clinic infection prevention tools, and the use of the National Healthcare Safety Network (NHSN) for monitoring progress in reducing BSI in dialysis clinics in California.

Infection Prevention Guidelines and Recommendations

• CDC Approach to BSI Prevention in Dialysis Facilities (PDF)
  Nine core interventions to prevent dialysis-related BSI.
  
• CDC Infection Control Requirements for Dialysis Facilities and Clarification Regarding Guidance on Parenteral Medication Vials 
• CDC Guide to Infection Prevention for Outpatient Settings: Minimum Expectations for Safe Care 
  
• CDC Infection Prevention Checklist for Outpatient Settings: Minimum Expectations for Safe Care (PDF)

• CDC 2011 Guidelines for the Prevention of Intravascular Catheter-Related Infections 
  Evidenced-based recommendations for preventing intravascular catheter-related infections.
  

Infection Prevention Education

• CDPH Basics of Infection Prevention in Outpatient Hemodialysis Center Course (forthcoming)

• CDC Provider Training Video: Preventing Bloodstream Infections in Outpatient Hemodialysis Patients: Best Practices for Dialysis Staff (PDF)

  Best practices for dialysis staff for prevention of bloodstream infections in patients receiving hemodialysis.
  

• CDC Continuing Education Course: Infection Prevention in Dialysis Settings

  Continuing education for infection prevention in dialysis settings for healthcare workers.
  

• AHRQ Safety Program for End-Stage Renal Disease Facilities – Toolkit

  Four instructional modules that a facilitator can use to teach dialysis center team members specific ways to create a culture of safety and prevent healthcare-associated infections in dialysis patients. Created by Agency for Healthcare Research and Quality (AHRQ) for End-Stage Renal Disease (ESRD) clinics.
  

Infection Surveillance

• NHSN Tracking Infections in Outpatient Dialysis Facilities
  NHSN training and support material for reporting dialysis events, process measures and data analysis.

Checklists, Posters, and Tools for Use in Dialysis Clinics

• CDC Provider Poster: Put Together the Pieces to Prevent Infections in Dialysis Patients (PDF) 
  Illustration of the components of infection prevention for dialysis patients.
  

• WHO 5 Moments for hand Hygiene in Hemodialysis Poster (PDF) 
  Poster that illustrates how to perform hand hygiene when working with dialysis patients.
  

  CDC Compatibility Information for Skin Antiseptics and Antimicrobial Ointments with Chronic Hemodialysis Catheters

  Information on skin antiseptics and antimicrobial ointment compatibility, contains links to catheter manufacturers' recommendations.
  

• CDC Protocol: Scrub-the-Hub for Hemodialysis Catheters (PDF)

  Suggested approach to disinfecting catheter hubs prior to access for hemodialysis.
  

• CDC Hand Hygiene Observations Tool (PDF)

  Data collection tool for hand hygiene compliance observations in the dialysis setting.
  

• CDC Checklist: Dialysis Station Routine Disinfection (PDF)

  Checklist for routine disinfection of dialysis station when there is no visible blood or soil.
  

• CDC Checklist: Hemodialysis catheter connection (PDF)

  Checklist of steps to safely connect a hemodialysis catheter to blood lines.
  

• CDC Checklist: Hemodialysis catheter disconnection (PDF)

  Checklist of steps to safely disconnect a hemodialysis catheter from blood lines.
  

• CDC Checklist: Hemodialysis catheter exit site care (PDF)

  Checklist for safe catheter exit site care for patients with a central venous catheter for dialysis access.
  

• CDC Checklist: Arteriovenous fistula/graft cannulation (PDF)

  Checklist of steps on how to safely perform fistula/graft cannulation and connect to blood lines.
  

• CDC Checklist: Arteriovenous fistula/graft decannulation (PDF)

  Checklist of steps on how to safely perform fistula/graft de-cannulation and disconnection from blood lines.
  

• CDC Checklist: Hemodialysis injectable medication preparation (PDF)

  Checklist of steps for aseptic injectable medication preparation and administration.
  

• CDC Injection Safety Checklist (PDF) 
  Checklist to remind healthcare workers of safe injection practice.
  

• Making Dialysis Safer for Patients Coalition

  A collaboration of dialysis organizations promoting the use of CDC’s core interventions and resources to prevent bloodstream infections among hemodialysis patients.
  

Information for Dialysis Patients

• CDC Speak Up: Making Dialysis Safer for Patients Video (Opens in YouTube)

  This video follows the journey of two patients on dialysis who feel empowered to speak up and share concerns about their treatment in order to prevent infections.

• CDC Comic: Engaging Patients in the Infection Prevention Conversation (PDF)

  Provides helpful tips and reminders about patient and caregiver engagements.

• CDC Patient Pocket Guide: 6 Tips to Prevent Dialysis Infections (PDF)

  Pocket sized guide for hemodialysis patients with tips on how to prevent infections.
  

• CDC: Preventing Bloodstream Infections in Hemodialysis Patients: the Patient Perspective (PDF)

  Focus group for patients taking a role in infection prevention.
  

• ESRD Network: Dialysis Patients Speak: a Conversation about the Importance of AV Fistulas
  Educational video on hemodialysis patients speaking about the importance of AV fistulas for vascular access.
  

• ESRD Network: Dialysis Patients Speak Preventing Infections 2012
  Educational video on the importance of hand hygiene, proper equipment and technique to prevent bloodstream infections.
  

• Kidney Foundation: Dialysis Patient Information
  Webpage designed to provide dialysis patients with multiple resources for their active participation in dialysis care.
  

• APIC: Hemodialysis Infection Prevention 
  Patient information on the importance of infection prevention for hemodialysis patients.
  

Additional Resources

• California Outpatient Healthcare Facilities Health and Safety Code (1200-1209), including Outpatient Dialysis Clinics

  Health and Safety Code 1205-1205.5

• California Hemodialysis Technician Training Act

  Health and Safety Code 1247-1247.9

• CMS ESRD Conditions of Participation (CoP) (PDF)

  Conditions for coverage for ESRD facilities to be certified under the Medicare Program.
  

• CMS CoP FAQ (PDF)

  Frequently asked questions on the conditions for coverage for ERSD facilities.
  

• CMS Dialysis webpage

  Basic information from Centers for Medicare and Medicaid Services (CMS), related to survey and certification of dialysis facilities.
  

• CMS Core Survey Training Manual Version 1.7  
  Contains components of the End-Stage Renal Disease (ESRD) Survey processes and resources to identify deficient practices in dialysis facilities.
  

For more information, contact HAIProgram@cdph.ca.gov