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Prospective Surveillance for Primary Bloodstream Infections Occurring in Canadian Hemodialysis Units

Published online by Cambridge University Press:  02 January 2015

Geoffrey Taylor ,
Denise Gravel ,
Lynn Johnston ,
John Embil ,
Donna Holton ,
Shirley Paton ,
Canadian Hospital Epidemiology Committee  and
Canadian Nosocomial Infection Surveillance Program
Geoffrey Taylor*
Affiliation:
Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
Denise Gravel
Affiliation:
Divisions of Nosocomial and Occupational Infections, Center for Infectious Diseases Prevention and Control, Health Canada, Ottawa, Ontario, Canada
Lynn Johnston
Affiliation:
Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
John Embil
Affiliation:
Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
Donna Holton
Affiliation:
Divisions of Nosocomial and Occupational Infections, Center for Infectious Diseases Prevention and Control, Health Canada, Ottawa, Ontario, Canada
Shirley Paton
Affiliation:
Divisions of Nosocomial and Occupational Infections, Center for Infectious Diseases Prevention and Control, Health Canada, Ottawa, Ontario, Canada
*
2E4.11 Walter McKenzie Center, University of Alberta Hospital, Edmonton, Alberta T6G 2B7, Canada
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Abstract

Objective:

Bloodstream infections are a major cause of morbidity and mortality in patients receiving long-term hemodialysis. We wanted to determine the incidence of hemodialysis-related bloodstream infections in Canadian centers participating in the Canadian Nosocomial Infection Surveillance Program.

Methods:

Prospective surveillance for hemodialysis-related bloodstream infections was performed in 11 centers during a 6-month period. Bloodstream infections were defined by published criteria. Hemodialysis denominators included the number of dialysis procedures, the number of patient-days on dialysis, and the frequencies of different types of vascular access.

Results:

There were 184 bloodstream infections in 133,158 dialysis procedures (1.4 per 1,000) and 316,953 patient-days (0.6 per 1,000). Hemodialysis access through arteriovenous (AV) fistulae was associated with the lowest risk for bloodstream infection (0.2 per 1,000 dialysis procedures). The relative risk for infection was 2.5 with AV graft access, 15.5 with cuffed and tunneled central venous catheter (CVC) access, and 22.5 with uncuffed CVC access (P < .001). There was marked variation among the 11 centers in the means of vascular access used for hemodialysis. Significant variation in infection rates was observed among the centers when controlling for types of access.

Conclusions:

There was a hierarchy of risk of hemodialysis-related bloodstream infection according to type of vascular access. There was significant variation in the type of vascular access being used among the Canadian hemodialysis centers, and also variation in access-specific infection rates between centers.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 23 , Issue 12 , December 2002 , pp. 716 - 720
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2002

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