How can we improve infection control in such a tricky environment?
Dialysis is a vital and life-saving measure for millions of individuals around the world suffering from renal failure. End-stage renal disease (ie, kidney failure) impacts more than 660,000 Americans alone, meaning that the availability of dialysis is paramount to their health. Roughly 468,000 of those Americans suffering from end-stage renal disease (ESRD) rely on dialysis to remove toxins, solutes, and excess water from their blood.
Unfortunately, dialysis also carries with it an increased risk for infection, namely, bloodstream infections. The main tools in the infection control toolbox for reducing dialysis infections are hand hygiene, vascular (and catheter) access, staff education, patient/family education, skin antiseptic, and catheter hub disinfection. However, even something as simple (but critical) as hand hygiene can be challenging in hemodialysis facilities.
The Centers for Disease Control and Prevention (CDC) has worked tirelessly to provide the tools and education to help health care providers working in these facilities reduce the risk of infections associated with dialysis. One initiative, the Making Dialysis Safer for Patients Coalition, involves bringing forth all members of the care team to help educate and reduce infections.
Hand hygiene and environmental contamination are 2 common sources of bloodstream infection outbreaks in such environments. To this end, the authors of a recent article in the Clinical Journal of the American Society of Nephrology focused on the use of infection prevention procedures in hemodialysis facilities. A focus on hand hygiene was a common component; however, it can be easy for nurses to forget hand hygiene is needed before and after they move from the patient to the environment, and to the machine and back again.
Hand hygiene, especially when working with arteriovenous fistulas, central venous catheters (CVC), and other vascular accesses, is extremely important to help reduce the potential for infection. For their study, the investigators recommended the use of checklists and frequent audits to monitor hand-hygiene adherence and serve as reminders for staff. They also called out the importance of hub scrub (catheter hub disinfection) and dialysis station disinfection as well as the careful use of single-dose and multi-dose medications.
They concluded that the incidence of serious infections at hemodialysis facilities is too high, particularly in light of the fact that most infections could be avoided if proper infection control practices are followed 100% of the time. This may require input and buy-in not only from staff working directly with patients, but also medical directors and even family members.
One of the most important things to remember in the practice of reducing infections across any setting, but especially in outpatient facilities using invasive care, is that true infection control involves many people. Meeting 100% infection control involves work from the medical directors/providers, nursing, patient and family, and equipment practices. Quality incentive programs that require facilities to track bloodstream infections can only do so much; it is the responsibility of every person involved to work towards the goal of zero infections. It is important that education is provided to everyone in order to help reduce the possibility of infection transmission during dialysis treatment. Patient and family engagement is paramount to many of these efforts. Educating and involving them in infection prevention efforts allows them to also become part of the care process and help serve as advocates for infection control. Dialysis staff, of course, have the responsibility to follow and support infection prevention practices, but it behooves us to remember all the other players in this game of infection reduction.