New infection prevention toolkit designed to protect end-stage renal disease patients

March 18th, 2015

About one in six U.S. dialysis patients die annually from an infection and 12% of dialysis patients are hospitalized due to septicemia, according to the Agency for Healthcare Research and Quality (AHRQ).

While those estimates are based on 2007 data, the statistics served as a call to action for AHRQ, which is funding a major new infection prevention project for end-stage renal disease (ESRD) facilities. Called the National Opportunity To Improve Infection Control in ESRD (NOTICE), the project seeks to reduce vascular access infections, enhance infection control best practices, and improve the safety culture in dialysis facilities.

“We funded this project to develop practical, research-based tools that end stage renal disease facilities can use to make care safer for patients who get dialysis,” says Darryl T. Gray, MD, ScD, medical officer for the Center for Quality Improvement and Patient Safety at AHRQ.

The primary pathogens infecting dialysis patients include susceptible and drug resistant strains of Staph aureus, E. coli, Pseudomonas and Klebsiella.

“Dialysis patients are exposed to these pathogens more frequently than other patients because the hemodialysis process requires accessing a patient’s bloodstream, and these patients are often hospitalized for various illnesses,” he says. “These factors, along with the fact that dialysis patients’ immune systems don’t work as well as they should, make it easier for common pathogens to make dialysis patients sick.”

There also have been outbreaks of hepatitis C virus in dialysis facilities, but HCV is not a major emphasis of the project.

“Screening patients for hepatitis C and tracking the transmission [of HCV] are not routinely done in dialysis facilities, and they are not part of the AHRQ-funded project,” Gray says. “However, many of the infection prevention techniques used in the AHRQ project, such as proper disinfecting of equipment between patient treatments, will help prevent transmission of hepatitis C.”

The project’s recently completed first phase included baseline analysis and development of a 24-page toolkit , which includes infection control worksheets and checklist designed for dialysis facilties. The second phase will includes testing the tools in end-stage renal disease facilities and performing additional analyses, Gray says.

“We expect the second phase to be complete by the end of this year,” he adds.

--Melinda Young

For more on this story see the July 2014 issue of Hospital Infection Control & Prevention.