Abstract
BackgroundAccess-related infections are a major cause of morbidity and mortality in haemodialysis patients. Our goal was to decrease the rate of these infections by implementing an intervention and surveillance program.MethodsThis intervention took place in two haemodialysis units (Units A and B) and was a joint effort by the haemodialysis staff and the unit for infection prevention and control. It included reviewing the work methods and work space, observations on compliance with standard precautions and handling of the vascular access, creating a checklist and a designated kit for handling the vascular access and prospective surveillance of access-related infections.ResultsDuring a nine-year period, the haemodialysis units A and B treated 4471 and 7547 patients (mean number of patients per year: 497 (range 435–556) and 839 (range 777–1055), respectively). For most patients, the procedure was done through an arteriovenous fistula (66.7%, range 50.3–81.5%). The access-related infection rate decreased significantly in both haemodialysis units: from 3 to 0.9% (trend: p < 0.05, linear regression: p < 0.001) in Unit A and from 0.9 to 0.2% (trend: p < 0.05, linear regression: p = 0.01) in Unit B.ConclusionsAn intervention which included introduction of a checklist and designated kit, together with ongoing surveillance and feedback, resulted in a significant decrease in the access-related infection rates in both haemodialysis units.
Highlights
Access-related infections are a major cause of morbidity and mortality in haemodialysis patients
We present the first 9 years of our intervention and surveillance program in two haemodialysis units in a tertiary care center in order to decrease the accessrelated infection rates
For the majority of patients, the haemodialysis access was through an AV Fistula (66.7%, range 50.3–81.5%, Fig. 1a and b)
Summary
Access-related infections are a major cause of morbidity and mortality in haemodialysis patients. Infection is the second leading cause of death in haemodialysis patients [1]. Bloodstream infections are a common cause for morbidity and mortality in these patients, many associated with the presence of a vascular access. The incidence of access-related bacteremia is estimated at 0.9–2.0 episodes per one catheter year [2]. The type of vascular access is a critical risk factor for bacteremia. The risk for an access-related bacteremia with a tunnelled catheter is ten times higher than with an arteriovenous (AV) graft and twenty times higher than with an AV fistula [3]. Surveillance is known as an important factor in preventing access-related bacteremia in haemodialysis
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