Assessment of CDC Recommended Core Interventions to Prevent Dialysis-Related Bloodstream Infections-Colorado 2015

BACKGROUND: Per Colorado statute, outpatient dialysis centers began submitting dialysis-related infection data to the Colorado Department of Public Health and Environment (CDPHE) March 2010. The law mandates dialysis centers to report data through the National Healthcare Safety Network (NHSN). To report data into NHSN, centers must complete an annual practices survey that collects information on infection control practices and implementation of CDC recommended core interventions for dialysis bloodstream infection (BSI) prevention.  

METHODS:  Responses from the NHSN annual survey in 2014 (n=62) and 2015 (n=74) were examined to assess changes in practice and adoption of the CDC core interventions. While the survey does not specifically address all nine interventions, it indirectly assesses implementation of most interventions and other activities related to recommended interventions.  

RESULTS: Survey results from selected core interventions are as follows:

Regarding surveillance and feedback using NHSN, dialysis centers, per statute, have reported infection data into NHSN since March 2010. In 2015, CDPHE began quarterly distribution of formal feedback reports that show each facility’s access related infection rates (using anonymous IDs) compared to state aggregate rates. From 2014 to 2015, observational audits increased from 84% to 88% for hand hygiene and from 89% to 93% for quarterly observations of vascular access care. The use of Chlorhexidine for skin antisepsis increased from 23% to 74%. Use of the “scrub the hub” protocol improved from 19% to 72%. The use of antimicrobial ointment was low in 2014 (13%) but showed a slight increase to 15%. While fistula use in 2014 was 75%, it declined slightly to 74% in 2015, accompanied by a slight increase in CVC use from 14% in 2014 to 16% 2015. The implementation of patient education/engagement declined from 58% to 50%. 

CONCLUSIONS: The increased frequency of observational audits for both hand hygiene and CVC care may be indicative of improvements in staff education and competency. Substantial improvements in Chlorhexidine use for skin antisepsis and use of the “scrub the hub” protocol demonstrates a shift toward recommended practice. Possible reasons for the decline in patient education could be facilities’ recent participation in such initiatives, fewer initiatives offered, and incorporation of standardized patient education practices. In response to these findings, CDPHE visited 41 dialysis facilities and delivered  training and educational resources on infection surveillance, reporting and control. CDPHE will continue educating dialysis facilities on the nine core interventions and other critical infection control practices.