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Abstract: SA-PO451

Observations of Infection Prevention and Control Practices in US Outpatient Hemodialysis Clinics, 2015-2018

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis


  • Gualandi, Nicole, Centers for Disease Control and Prevention, Atlanta, Georgia, United States
  • Hsu, Stephanie, Centers for Disease Control and Prevention, Atlanta, Georgia, United States
  • Novosad, Shannon, Centers for Disease Control and Prevention, Atlanta, Georgia, United States
  • Patel, Priti R., Centers for Disease Control and Prevention, Atlanta, Georgia, United States

Group or Team Name

  • National Dialysis ICAR Implementation Working Group

Pandemics have highlighted the need for robust infection prevention and control (IPC) in dialysis clinics to prevent spread of infections. In 2015, public health departments were funded to assess and improve IPC in hemodialysis clinics. We present results of observations performed during these assessments.


A standardized Infection Control Assessment and Response (ICAR) form was developed by IPC experts at a federal public health agency. The form included observations of practice using published tools for 7 different IPC processes. A process was considered successful if all recommended steps were completed. Health department staff selected clinics for assessment and were trained on use of the observation tools. Cross-sectional assessments occurred from March 2015-March 2018. We pooled jurisdictions' aggregate numerator and denominator data and calculated the percent of observed processes successfully completed.


In all, 70,288 IPC observations were made in 764 dialysis clinics in 29 jurisdictions. Of 42,642 hand hygiene opportunities observed, 89.5% were successful (Figure). Among injection processes, 82.1% of 3,802 injection preparations and 87.3% of 3,550 injection administrations were successful. Among vascular access processes, 77.3% of 6,688 arteriovenous access connections, 82.0% of 4,061 catheter connection/disconnections, and 65.8% of 2,350 catheter exit site processes were successful. For routine disinfection of dialysis stations, 62.4% of 7,195 observed processes were successful.


In a large-scale evaluation of dialysis IPC practices, observed adherence to hand hygiene and injection safety was high. But infrequent, serious errors could have occurred. Important areas for improvement may exist for vascular access care and dialysis station disinfection. Increased attention to routine IPC practice will likely lessen the impact of emerging infections.


  • Other U.S. Government Support