Ebola virus transmission in a U.S. healthcare facility has highlighted infection control (IC) knowledge gaps and practice deficiencies. As part of the 2015 Epidemiology and Laboratory Capacity for Infectious Diseases Ebola Supplement Cooperative Agreement, the New Jersey Department of Health (NJDOH) is promoting epidemiology, laboratory practices, and disease control and prevention activities in a variety of healthcare settings. NJDOH set a deliverable goal to conduct IC assessments of at least 20 hemodialysis (HD) centers under this cooperative agreement. In October 2015, NJDOH began conducting systematic HD IC assessments; as of December 30th, NJDOH completed 14 HD IC assessments.
METHODS:
Among the 153 HD centers throughout New Jersey, the first nine facilities were selected for IC assessments due to at least one documented case of acute hepatitis C virus (HCV) infection within the previous two years. Additional HD centers were selected for IC assessments with the intent of representing an even geographical distribution, which included various center sizes and ownership types in the state. IC assessment site visits at all 14 of the centers included staff interviews regarding IC policies and direct observation of IC practices utilizing the eight CDC standardized HD audit tools consisting of 8-10 IC steps per tool. In 10 facilities, IC education sessions and station disinfection skills demonstrations were also incorporated.
RESULTS:
While adherence to each individual step within the CDC tools was generally high, when calculated overall, best practice adherence rates for the 14 HD centers was 88% (range: 34-98%) for hand hygiene, 37% (range: 0-100%) for catheter connection, 65% (range: 17-93%) for arteriovenous fistula/graft cannulation, 54% (range: 0-86%) for injectable medication administration, and 37% (range: 8-77%) for HD station disinfection. Several HD center policies deviated from best practices including disinfection of a HD station while occupied by a patient, no routine use of antibiotic ointment during catheter site care, and use of non-recommended skin antiseptic before cannulation.
CONCLUSIONS:
These IC assessments have highlighted areas for improvement, including aseptic technique when connecting to and disconnecting from HD machines, aseptic medication administration, hand hygiene, and environmental disinfection. NJDOH is leveraging public health resources to assist HD centers in educating staff, improving IC practices, and preventing disease transmission. NJDOH intends to complete assessments in at least six HD centers over the next two months.