Reducing Blood Stream Infections (BSIs) in Patients on Hemodialysis (HD)

Abstract

ON HEMODIALYSIS (HD) Lynda Ball, Cheryl George, Nellie Hedrick, Lynda Osborn, Linda Duval, FMQAI Network 13, Oklahoma City, OK, USA Decreasing infections in the HD patient population is paramount to reduce morbidity and mortality. Network 13 initiated a quality improvement activity (QIA) to reduce BSIs in patients on HD. Key components of this QIA included: Monthly CDC audits; improving communication between patients and staff; and, education. Dialysis facilities were ranked utilizing 2013 National Healthcare Safety Network (NSHN) data. A minimum of 20% of the facilities with the highest BSI rates were chosen to participate. In addition, 20% of the Network 13 patient population (n=3175) was included to ascertain patient engagement in infection control practices. Facilities (n=63) were provided on-line orientation training, a reporting calendar, root cause analysis tools, educational resources (articles, posters, handouts, and on-line training) for patients and staff, CDC infection control audits for monitoring practice, and a patient-engagement checklist. Facilities reported progress monthly. The Network provided technical assistance for adverse reporting or as requested. Facilities were monitored the 2 and 3 quarter of 2014 for monthly BSIs and percentage of hand hygiene, catheter connect/disconnect, and cannulation audits correctly completed. Patient engagement with infection control practices were monitored at baseline, mid-point, and at the completion of the project. Results indicated a statistically significant (p<0.001) improvement in the reduction of BSIs (19.9% to 8.6%), and in increasing patient engagement in the infection control process (81.5% to 92.0%). CDC audits completed correctly included: Hand Hygiene baseline of 75.9% to a final of 92.4% (p<0.001); catheter connect/disconnect baseline of 90.2% to a final of 93.5% (NS); and, cannulation baseline of 78% to a final of 89.1% (p<0.05). The successful outcomes of this QIA suggest that this activity could be replicated and spread to meet the needs of the ESRD community as a whole.