Resource Library
» Compendium of Infection Control and Prevention Resources(• Bloodstream Infections Related to Vascular Access | • CDC Core Measures, Recommendations, and Resources | • Dialysis Safety and Infection Control/Prevention | • Emergency Management in Dialysis | • Explanation and Scope of the ESRD Program | • Hepatitis C Monitoring and Referral | • Medication: Risks Related to Preparation and Administration in Dialysis Settings | • Partnering with CMS State Surveyors | • Partnering with ESRD Networks | • Partnering with Nephrologists | • Patient Involvement in Infection Prevention/Control | • Staff and Patient Education | • Water Quality Basics and Resources)
Prevention of Bloodstream Infections in Patients Undergoing HemodialysisSource: CJASN. Authors: Molly Fisher, Ladan Golestaneh, Michael Allon, Kenneth Abreo and Michele H. Mokrzycki CJASN December 2019, CJN.06820619; DOI: https://doi.org/10.2215/CJN.06820619. Abstract: Bloodstream infections are an important cause of hospitalizations, morbidity, and mortality in patients receiving hemodialysis. Eliminating bloodstream infections in the hemodialysis setting has been the focus of the Centers for Disease Control and Prevention (CDC) Making Dialysis Safer for Patients Coalition and, more recently, the CDC's partnership with the American Society of Nephrology's Nephrologists Transforming Dialysis Safety Initiative. The majority of vascular access–associated bloodstream infections occur in patients dialyzing with central vein catheters. The CDC's core interventions for bloodstream infection prevention are the gold standard for catheter care in the hemodialysis setting and have been proven to be effective in reducing catheter-associated bloodstream infection. However, in the United States hemodialysis catheter–associated bloodstream infections continue to occur at unacceptable rates, possibly because of lapses in adherence to strict aseptic technique, or additional factors not addressed by the CDC's core interventions. There is a clear need for novel prophylactic therapies. This review highlights the recent advances and includes a discussion about the potential limitations and adverse effects associated with each option.
KDIGO 2018 Clinical Practice Guideline for the Prevention, Diagnosis, Evaluation, and Treatment of Hepatitis C in Chronic Kidney DiseaseSource: Kidney International Supplements Kidney Disease: Improving Global Outcomes (KDIGO) Hepatitis C Work Group
NHSN Tracking Infections in Outpatient Dialysis FacilitiesSource: Centers for Disease Control and Prevention (CDC)
Interpretive Guidance of the ESRD Conditions for Coverage for Dialysis Facilities (304 pages)Source: Centers for Medicare & Medicaid Services (CMS.gov) Final Version 1.1 October 3, 2008
KDIGO Guidelines "Hepatitis C in CKD" (2018)The Kidney Disease: Improving Global Outcomes (KDIGO) 2018 Clinical Practice Guideline for the Prevention, Diagnosis, Evaluation, and Treatment of Hepatitis C in Chronic Kidney Disease represents a complete update of the prior guideline published in 2008.
CDC Safe Injection Practices: Protecting Yourself and Your PatientsSource: Centers for Disease Control and Prevention (CDC)
CDC Approach to BSI Prevention in Dialysis Facilities (i.e., the Core Interventions)Source: Centers for Disease Control and Prevention (CDC)
National Kidney Foundation A-Z Health Guide: Hemodialysis
Centers for Disease Control and Prevention. CDC twenty four seven. Saving Lives, Protecting People Centers for Disease Control and Prevention. CDC twenty four seven. Saving Lives, Protecting People Search Emergency Preparedness and ResponseSource: Centers for Disease Control and Prevention (CDC) Health Alert Network (HAN) CDC's Health Alert Network (HAN) is CDC's primary method of sharing cleared information about urgent public health incidents with public information officers; federal, state, territorial, tribal, and local public health practitioners; clinicians; and public health laboratories. CDC's HAN collaborates with federal, state, territorial, tribal, and city/county partners to develop protocols and stakeholder relationships that will ensure a robust interoperable platform for the rapid distribution of public health information.
Infection Prevention for Ambulatory Care Centers During DisastersCopyright © 2013 by the Association for Professionals in Infection Control and Epidemiology, Inc. (APIC)
Natural Disasters and Severe Weather: Infection ControlSource: Centers for Disease Control and Prevention (CDC)
Technical Considerations When Bringing Hemodialysis Facilities' Water Systems Back on Line After a DisasterSource: Centers for Disease Control and Prevention (CDC)
Dialysis Care After a DisasterSource: Centers for Disease Control and Prevention
Preparation and quality management of fluids for haemodialysis and related therapies -- Part 5: Quality of dialysis fluid for haemodialysis and related therapiesInternational Organization for Standardization (ISO) 23500-5:2019 This document specifies minimum quality requirements for dialysis fluids used in haemodialysis and related therapies. This document includes dialysis fluids used for haemodialysis and haemodiafiltration, including substitution fluid for haemodiafiltration and haemofiltration. This document excludes the water and concentrates used to prepare dialysis fluid or the equipment used in its preparation. Those areas are covered by other International Standards. Sorbent-based dialysis fluid regeneration systems that regenerate and recirculate small volumes of dialysis fluid, systems for continuous renal replacement therapy that use pre-packaged solutions, and systems and solutions for peritoneal dialysis are excluded from this document.
Dialysis Water and Dialysate Recommendations: A User GuideSource: Association for the Advancement of Medical Instrumentation (AAMI) Published: May 2014; 211 pages This book provides a side-by-side comparison of the Centers for Medicare & Medicaid Services (CMS) regulations and interpretive guidance for the Condition of Water and Dialysate Quality and the section related to water and dialysate from the Condition of Care at Home with the suite of ISO Standards that have been adopted as replacement for ANSI/AAMI RD52:2004. This book aids individuals responsible for the oversight and operation of hemodialysis facilities in their understanding of the regulatory requirements and current AAMI guidance.
Excellent Water Quality Key to Safe DialysisSource: American Society of Nephrology (ASN) Kidney News Online Author: Andrew Fenves
What Medical Directors Need to Know about Dialysis Facility Water ManagementCJASN June 2015, 10 (6) 1061-1071; DOI: https://doi.org/10.2215/CJN.11851214 Authors: Ted Kasparek and Oscar E. Rodriguez Abstract: The medical directors of dialysis facilities have many operational clinic responsibilities, which on first glance, may seem outside the realm of excellence in patient care. However, a smoothly running clinic is integral to positive patient outcomes. Of the conditions for coverage outlined by the Centers for Medicare and Medicaid Services, one most critical to quality dialysis treatment is the provision of safe purified dialysis water, because there are many published instances where clinic failure in this regard has resulted in patient harm. As the clinical leader of the facility, the medical director is obliged to have knowledge of his/her facility's water treatment system to reliably ensure that the purified water used in dialysis will meet the standards for quality set by the Association for the Advancement of Medical Instrumentation and used by the Centers for Medicare and Medicaid Services for conditions for coverage. The methods used to both achieve and maintain these quality standards should be a part of quality assessment and performance improvement program meetings. The steps for water treatment, which include pretreatment, purification, and distribution, are largely the same, regardless of the system used. Each water treatment system component has a specific role in the process and requires individualized maintenance and monitoring. The medical director should provide leadership by being engaged with the process, knowing the facility's source water, and understanding water treatment system operation as well as the clinical significance of system failure. Successful provision of quality water will be achieved by those medical directors who learn, know, and embrace the requirements of dialysis water purification and system maintenance.
Water Use in HemodialysisSource: Centers for Disease Control and Prevention (CDC)
Safe Injection Practices - How to Do It Right (video)OneandOnlyCampaign Published on Oct 11, 2012
Hemodialysis Injectable Medication Preparation Audit ToolSource: Centers for Disease Control and Prevention (CDC)
Medication Safety Principles and Practice in CKDCJASN November 2018, 13 (11) 1738-1746; DOI: https://doi.org/10.2215/CJN.00580118 Authors: Chanel F. Whittaker, Margaret A. Miklich, Roshni S. Patel and Jeffrey C. Fink Abstract: Ensuring patient safety is a priority of medical care because iatrogenic injury has been a primary concern. Medications are an important source of medical errors, and kidney disease is a thoroughfare of factors threatening safe administration of medicines. Principal among these is reduced kidney function because almost half of all medications used are eliminated via the kidney. Additionally, kidney patients often suffer from multimorbidity, including diabetes, hypertension, and heart failure, with a range of prescribers who often do not coordinate treatments. Patients with kidney disease are also susceptible to further kidney injury and metabolic derangements from medications, which can worsen the disease. In this review, we will present the key issues and threats to safe medication use in kidney disease, with a focus on predialysis CKD, as the scope of medication safety in ESKD and transplantation are unique and deserve their own consideration. We discuss drugs that need to be avoided or dose modified, and review the complications of a range of medications routinely administered in CKD, as these also call for cautious use.
CDC Urging Dialysis Providers and Facilities to Assess and Improve Infection Control Practices to Stop Hepatitis C Virus Transmission in Patients Undergoing HemodialysisSource: Centers for Disease Control and Prevention (CDC) Distributed via the CDC Health Alert Network Wednesday, January 27, 2016, 10:30 EST (10:30 AM EST) CDCHAN-00386
AJKDBlog: Caring for Patients with Hepatitis C and CKD in the Modern Era: The 2018 KDIGO GuidelinePosted on February 22, 2019 by AJKDblog in Commentary
CDC/NTDS Hepatitis C Testing and Monitoring AlgorithmDespite dialysis facility policies to minimize the risk of infection, transmission of hepatitis C virus (HCV) remains a real risk for patients with chronic kidney disease (CKD). HCV-infected patients may develop chronic liver disease, and also may be at increased risk of developing diabetes mellitus and renal graft injury should an infected patient receive renal transplant. Strict attention to infection control practices and surveillance to detect hepatitis C can limit its spread within dialysis units. Antiviral regimens can cure HCV infection, leading to eradication of this virus among already infected hemodialysis patients. This algorithm is intended to help healthcare professionals involved in the care of hemodilaysis patients identify infected patients and refer them for antiviral therapy.
Clinician EducationSource: Centers for Disease Control and Prevention (CDC)
Continuing Education "Infection Prevention in Dialysis Settings"Source: Centers for Disease Control and Prevention (CDC) CDC has created a new continuing education course "Infection Prevention in Dialysis Settings" for outpatient hemodialysis healthcare workers, including technicians and nurses.
Dialysis Patient Citizens (DPC)Dialysis Patient Citizens is a patient led, nonprofit organization dedicated to improving dialysis citizens' quality of life by advocating for favorable public policy.
American Assocation of Kidney Patients (AAKP)THE INDEPENDENT VOICE OF KIDNEY PATIENTS SINCE 1969™ The American Association of Kidney Patients is dedicated to improving the quality of life for kidney patients through education, advocacy, patient engagement and the fostering of patient communities.
CDC Patient InformationSource: Centers for Disease Control and Prevention (CDC)
Tracking Infections in Outpatient Dialysis FacilitiesSource: Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network (NHSN)
Making Dialysis Safer for Patients: Tools to Prevent Infections in Hemodialysis (video)Source: Centers for Disease Control and Prevention (CDC) Making Dialysis Safer for Patients Uploaded on Mar 21, 2018 This webinar will present resources for preventing infections in the hemodialysis setting and will focus on increasing the use and visibility of CDC evidence-based practices. Bloodstream infections are a dangerous complication of dialysis. Nurses, medical providers, technicians and others who work in dialysis facilities face a difficult task of managing complex conditions affecting their patients while simultaneously focusing on reducing the risk of infection for these at-risk individuals. In this webinar, we will discuss the burden of bloodstream infections in hemodialysis, present the Core Interventions for Bloodstream Infection Prevention in the dialysis setting, discuss the value of auditing in dialysis facilities using CDC tools and resources, and discuss benefits of becoming a member of the Making Dialysis Safer for Patients Coalition.
Essential Components of an Infection Prevention Program for Outpatient Hemodialysis CentersSource: Seminars in Dialysis First published: 28 June 2013 https://doi.org/10.1111/sdi.12102 Authors: Sally Hess, Virginia Bren Abstract: Infections are a significant complication for dialysis patients. The CDC estimates that 37,000 central line‐related bloodstream infections occurred in hemodialysis patients in 2008 and dialysis‐associated outbreaks of hepatitis C continue to be reported. While established hospital‐based infection prevention programs have existed since the 1970s, few dialysis facilities have an established in‐center program, unless the dialysis facility is hospital‐associated. This review focuses on essential core components required for an effective infection prevention program, extrapolating from acute‐care programs and building on current dialysis guidelines and recommendations. An effective infection prevention program requires infrastructure, including leaders who place infection prevention as a top priority, active involvement from a multidisciplinary team, surveillance of outcomes and processes with feedback, staff and patient education, and consistent use of evidence‐based practices. The program must be integrated into the existing Quality Assessment and Performance Improvement program. Best practice recommendations for the prevention of infection, specific to dialysis, continue to evolve as the epidemiology of dialysis‐associated infections is further researched and new evidence is gathered. A review of case studies illustrates that with an effective program in place, infection prevention becomes part of the culture, reduces infection risk, and improves patient safety.
Maintaining Safety in the Dialysis FacilityCJASN April 2015, 10 (4) 688-695; DOI: https://doi.org/10.2215/CJN.08960914 Author: Alan S. Kliger Abstract: Errors in dialysis care can cause harm and death. While dialysis machines are rarely a major cause of morbidity, human factors at the machine interface and suboptimal communication among caregivers are common sources of error. Major causes of potentially reversible adverse outcomes include medication errors, infections, hyperkalemia, access-related errors, and patient falls. Root cause analysis of adverse events and "near misses" can illuminate care processes and show system changes to improve safety. Human factors engineering and simulation exercises have strong potential to define common clinical team purpose, and improve processes of care. Patient observations and their participation in error reduction increase the effectiveness of patient safety efforts.
Infection control guidelines in hemodialysis facilitiesKidney Res Clin Pract. 2018 Mar; 37(1): 1–3. Published online 2018 Mar 31. doi: 10.23876/j.krcp.2018.37.1.1 Author: Ayman Karkar
100% Use of Infection Control Procedures in Hemodialysis Facilities: Call to ActionCJASN April 2018, 13 (4) 671-673; DOI: https://doi.org/10.2215/CJN.11341017 Authors: Anitha Vijayan and John M. Boyce
Guide to the Elimination of Infections in HemodialysisSource: Association for Professionals in Infection Control and Epidemiology (APIC)
What You Should Know About Infectious Diseases: A Guide for Hemodialysis Patients and Their FamiliesSource: National Kidney Foundation (NKF) As a hemodialysis patient, you want to learn all you can about your treatment and what you can do to ensure your health is at its best. One important area you should know about involves infectious diseases. These are diseases that happen when harmful germs get into your body and make you ill. Kidney failure interferes with your body's natural defense system (immune system), making it easier for you to get some types of diseases through your dialysis treatments.
CDC Dialysis SafetyPatients who undergo dialysis treatment have an increased risk for getting an infection. Hemodialysis patients are at a high risk for infection because the process of hemodialysis requires frequent use of catheters or insertion of needles to access the bloodstream. Hemodialysis patients have weakened immune systems, which increase their risk for infection, and they require frequent hospitalizations and surgery where they might acquire an infection.
Dialysis: Reducing Infections and Changing CultureSource: Centers for Disease Control and Prevention (CDC) Published: 3/19/2018 This podcast is an account from an infection preventionist about the challenges and successes with engaging dialysis care teams to focus on "Zero Preventable Infections" in outpatient dialysis facilities.
Leading the Dialysis Unit: Role of the Medical DirectorSource: Advances in Chronic Kidney Disease (ACKD) November 2018Volume 25, Issue 6, Pages 499–504 Authors: Sharmeela Saha, Jay B. Wish Abstract: The responsibilities of a dialysis unit medical director are specified in the ESRD Conditions for Coverage and encompass multiple quality, safety, and educational domains. Many of these responsibilities require leadership skills that are neither intuitive nor acquired as part of the medical director's training. An effective medical director is able to shape the culture of the dialysis facility such that patients and staff feel free to communicate their concerns regarding suboptimal processes without fear of retribution, and there is a continuous iterative process of quality improvement and safety, which values input from all stakeholders. This ultimately decreases the use of shortcuts and work-arounds that may compromise patient safety and quality because policies and procedures make it easiest to do the right thing. Fundamental to this leadership by the medical director are communications skills, staff empowerment, allocation of resources, mentoring, team building, and strategic vision. The medical director leads by example and must be present in the dialysis unit for extended periods to send a message of accessibility and commitment. Many dialysis medical directors would benefit from leadership training inside or outside their dialysis corporation.
The Evolving Role of the Medical Director of a Dialysis FacilityCJASN February 2015, 10 (2) 326-330; DOI: https://doi.org/10.2215/CJN.04920514 Authors: Franklin W. Maddux and Allen R. Nissenson Abstract: The medical director has been a part of the fabric of Medicare's ESRD program since entitlement was extended under Section 299I of Public Law 92-603, passed on October 30, 1972, and implemented with the Conditions for Coverage that set out rules for administration and oversight of the care provided in the dialysis facility. The role of the medical director has progressively increased over time to effectively extend to the physicians serving in this role both the responsibility and accountability for the performance and reliability related to the care provided in the dialysis facility. This commentary provides context to the nature and expected competencies and behaviors of these medical director roles that remain central to the delivery of high-quality, safe, and efficient delivery of RRT, which has become much more intensive as the dialysis industry has matured.
Renal Physicians Association (RPA)RPA represents and serves the interests of nephrology practitioners in their pursuit and delivery of quality renal health care.
American Society of Nephrology (ASN)The American Society of Nephrology (ASN) leads the fight against kidney diseases by educating health professionals, sharing new knowledge, advancing research, and advocating the highest quality care for patients.
ESRD Network OrganizationsSource: Centers for Medicare & Medicaid Services (CMS.gov)
Making Dialysis Safer for Patients Coalition MaterialsSource: Centers for Disease Control & Prevention (CDC)
Making Dialysis Safer For Patients CoalitionSource: Centers for Disease Control and Prevention (CDC)
The Making Dialysis Safer for Patients Coalition A New Partnership to Prevent Hemodialysis-Related InfectionsSource: Clin J Am Soc Nephrol 13: 175–181, 2018. doi: https://doi.org/10.2215/CJN.02730317 Authors: Priti R. Patel and Kristin Brinsley-Rainisch Abstract: The Making Dialysis Safer for Patients Coalition is a partnership of organizations and individual stakeholders that share the common goal to prevent bloodstream infections among patients receiving hemodialysis. Led by the Centers for Disease Control and Prevention (CDC), in collaboration with the CDC Foundation, this public-private partnership strives to improve adherence to evidence-based recommendations, share information and experiences, and engage patients in infection prevention efforts.
CDC Dialysis Safety: Core InterventionsSource: Centers for Disease Control & Prevention (CDC)
Catheter-related blood stream infections in hemodialysis patients: a prospective cohort studyBMC Nephrol. 2017; 18: 357. Published online 2017 Dec 8. doi: 10.1186/s12882-017-0773-5 Authors: Stephanie Thompson,1 Natasha Wiebe,1 Scott Klarenbach,1 Rick Pelletier,2 Brenda R. Hemmelgarn,3 John S. Gill,4 Braden J. Manns,3 Marcello Tonelli,5 and for the Alberta Kidney Disease Network
Dialysis BSI Prevention CollaborativeSource: Centers for Disease Control and Prevention (CDC)
ESRD Quality Incentive ProgramSource: Centers for Medicare & Medicaid Services (CMS.gov)
Kidney Failure and Medicare: What you should knowSource: Medicare Rights Center Author:Kelli Collins, MSW Publication: September 27, 2016
How does dialysis work?DaVita Kidney Care Published on Jul 12, 2016 There are five stages of Chronic Kidney Disease, or CKD, many of which can be managed before reaching kidney failure.
Explanatory video: How does Dialysis work?FreseniusTV Published on Jul 13, 2017 Lifesaver dialysis: More than 3 million people worldwide need to regularly undergo this vital blood-cleansing procedure. When kidneys fail, dialysis takes over and performs their most important functions, removing waste products, toxins, and excessive salt and fluids from the patient's body.
