Abstract: FR-OR23
Progress in Preventing Bloodstream Infections in Hemodialysis: Data from the National Healthcare Safety Network, 2014-2018
Session Information
- Hemodialysis and Home Hemodialysis: Research Abstracts
October 23, 2020 | Location: Simulive
Abstract Time: 05:00 PM - 07:00 PM
Category: Dialysis
- 701 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Novosad, Shannon, Centers for Disease Control and Prevention, Atlanta, Georgia, United States
- Fike, Lucy V., Centers for Disease Control and Prevention, Atlanta, Georgia, United States
- Soe, Minn, Centers for Disease Control and Prevention, Atlanta, Georgia, United States
- Moon, Shunte, Centers for Disease Control and Prevention, Atlanta, Georgia, United States
- Ravindhran, Preeti, Centers for Disease Control and Prevention, Atlanta, Georgia, United States
- Woolfolk, Erikka Joy, Centers for Disease Control and Prevention, Atlanta, Georgia, United States
- Moccia, Lauren, Centers for Disease Control and Prevention, Atlanta, Georgia, United States
- Nguyen, Duc B., Centers for Disease Control and Prevention, Atlanta, Georgia, United States
- Patel, Priti R., Centers for Disease Control and Prevention, Atlanta, Georgia, United States
Background
Patients on hemodialysis are at high risk of bloodstream infections (BSIs) and associated morbidity and mortality. National prevention efforts have resulted in widespread practice changes, including central venous catheter (CVC) care. We analyzed Dialysis Event surveillance data submitted to the National Healthcare Safety Network (NHSN) to describe BSI rates among hemodialysis outpatients from 2014 to 2018.
Methods
Outpatient hemodialysis facilities report BSIs (positive blood cultures collected in the outpatient setting or within 1 day after hospital admission) and the number of hemodialysis patients treated during the first 2 working days of each month to NHSN. For each BSI, the suspected source and vascular access type [e.g., CVC, arteriovenous fistula (AVF) or arteriovenous graft (AVG)] are indicated. Pooled mean rates (per 100 patient-months) were calculated. Annual BSI rate trends were evaluated using a negative binomial regression model including access type, year, and an access-year interaction variable.
Results
More than 6,000 outpatient hemodialysis facilities reported 134,961 BSIs from 2014 to 2018. Of these BSIs, 102,505 (76%) were categorized as access-related. Pooled mean BSI rates decreased 27% from 0.64 to 0.47 per 100 patient-months. Significant decreases in rates occurred across vascular access strata (Table); the reduction was most pronounced among patients with CVCs. BSI rates in patients with CVCs decreased 32% from 2.16 per 100 patient-months to 1.46 (annual average decrease 9.5%).
Conclusion
Substantial reductions in BSI rates among hemodialysis patients occurred during this 5-year period. Improvements in infection prevention practices, including CVC care, have likely contributed. Efforts to increase uptake of known prevention practices and identify new strategies for prevention might contribute to continued decreases in infections.
BSI rates per 100 patient-months and annual trends, by access type, NHSN 2014-2018
Event | Access type | 2014 | 2015 | 2016 | 2017 | 2018 | Annual incidence rate ratio (95% CI) | Average annual % change (95% CI) |
BSI | All | 0.64 | 0.60 | 0.56 | 0.51 | 0.47 | ||
BSI | Fistula | 0.26 | 0.24 | 0.22 | 0.21 | 0.18 | 0.92 (0.91, 0.93) | -8.2 (-9.1, -7.3) |
Graft | 0.39 | 0.39 | 0.37 | 0.35 | 0.33 | 0.95 (0.93, 0.98) | -4.7 (-7.1, -2.2) | |
CVC | 2.16 | 2.01 | 1.86 | 1.72 | 1.46 | 0.90 (0.88, 0.93) | -9.5 (-11.5, -7.5) |
Funding
- Other U.S. Government Support