ASN's Mission

ASN leads the fight to prevent, treat, and cure kidney diseases throughout the world by educating health professionals and scientists, advancing research and innovation, communicating new knowledge, and advocating for the highest quality care for patients.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005

email@asn-online.org

202-640-4660

The Latest on Twitter

Kidney Week

Abstract: FR-OR23

Progress in Preventing Bloodstream Infections in Hemodialysis: Data from the National Healthcare Safety Network, 2014-2018

Session Information

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
EventAccess type20142015201620172018Annual incidence rate ratio (95% CI)Average annual % change (95% CI)
BSIAll0.640.600.560.510.47  
BSIFistula0.260.240.220.210.180.92 (0.91, 0.93)-8.2 (-9.1, -7.3)
 Graft0.390.390.370.350.330.95 (0.93, 0.98)-4.7 (-7.1, -2.2)
 CVC2.162.011.861.721.460.90 (0.88, 0.93)-9.5 (-11.5, -7.5)

Funding

  • Other U.S. Government Support