Developing an Infection Prevention Position for a Multi-Center Hospital-based Dialysis System

Abstract

<h3>Background</h3> There exists in most dialysis centers opportunities for improvement, including infection control practices, work practice safety, medication safety, regulatory compliance, training, and cost reduction. Although IP's are experts in HAI prevention, implementation science and problem-solving, it is typical for dialysis centers to have only limited access to an infection preventionist (IP). This hospital-based dialysis system created a .8 FTE IP dialysis staff position to support existing quality improvement efforts and address compliance and infection control issues. <h3>Methods</h3> 2 IPs are responsible for this health system's infection prevention program, including 4 outpatient hemodialysis centers, 1 inpatient hemodialysis center and a home peritoneal dialysis program. Prior to September 2018, the dialysis centers' monthly audits, compliance and quality improvement issues were the responsibility of the centers' supervisors and manager. Based on an increase in NHSN positive blood culture events and observed infection control and compliance issues, the health system identified the need for additional IP support for dialysis. A .8 FTE IP position was created within dialysis with job responsibilities in the area of both infection control and compliance. <h3>Results</h3> Positive blood culture events dropped 42%, from 12 in 2018 to 7 (as of December 2019). Compliance with the contact time during dialysis catheter hub disinfection improved from 8% to a sustained 100%. Likewise, compliance with skin antisepsis contact time improved from 40% to a sustained 100%. The IP was a major contributor to over 25 successful quality improvement projects which focused on safety, infection prevention, regulatory compliance and cost reduction. <h3>Conclusions</h3> The addition of an IP to the dialysis staff can contribute to best practices, safety, infection prevention, regulatory compliance, and reduced costs. Collaboration with the health system's IP's, dialysis staff and leadership is essential for success.