Bloodstream infections (BSI) among hemodialysis patients are among the most challenging problems in dialysis units, and are associated with significant morbidity and mortality (1).
Approximately 37,000 vascular access–related BSIs are estimated to have occurred among US hemodialysis patients with a central venous catheter in 2008, with an average cost per hospitalization of $23,000 (2,3). A number of factors appear to have contributed to these high rates, and they apply to both dialysis staff and patients; proper gowning and gloving, hand sanitation, high catheter rate, and appropriate skin antisepsis are examples. An overlooked and perhaps the most important modifiable risk factor in this equation is patients’ personal hand hygiene. Despite recommendations by the Centers for Disease Control and Prevention (CDC) that all hemodialysis patients should wash their hands pre- and post-hemodialysis, this is not always the case. The potential for cross-contamination between dialysis equipment and vascular access from unclean hands is both real and preventable.
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CDC. Vital signs: central line–associated blood stream infections—United States, 2001, 2008, and 2009. MMWR Morb Mortal Wkly Rep 2011; 60:243–248.
Ramanathan V, et al.. Healthcare costs associated with hemodialysis catheter-related infections: a single-center experience. Infect Control Hosp Epidemiol 2007; 28:606–609.
Centers for Disease Control and Prevention: core interventions to reduce dialysis bloodstream infections. http://www.cdc.gov/dialysis/prevention-tools/index.htmlaccessed on March 10, 2017.
Priti Patel, et al.. Bloodstream infection rates in outpatient hemodialysis facilities participating in a collaborative prevention effort: a quality improvement report. Am J Kidney Dis 2013; 62:322–30.
Sánchez-Carrillo LA, et al.. Enhancement of hand hygiene compliance among healthcare workers from a hemodialysis unit using video-monitoring feedback. Am J Infect Control 2016; 44:868–72.