Skip to main content Accessibility help
×
Home
Hostname: page-component-747cfc64b6-hfbn9 Total loading time: 0.152 Render date: 2021-06-13T13:32:54.315Z Has data issue: true Feature Flags: { "shouldUseShareProductTool": true, "shouldUseHypothesis": true, "isUnsiloEnabled": true, "metricsAbstractViews": false, "figures": true, "newCiteModal": false, "newCitedByModal": true, "newEcommerce": true }

An Outbreak of Bloodstream Infections in an Outpatient Hemodialysis Center

Published online by Cambridge University Press:  02 January 2015

Connie S. Price
Affiliation:
Department of Medicine, Denver Health Medical Center, and theUniversity of Colorado Health Sciences Center, Denver, Colorado
Donna Hacek
Affiliation:
Department of Pathology, Evanston Northwestern Healthcare, Evanston, Illinois
Gary A. Noskin
Affiliation:
Department of Medicine, Northwestern Memorial Hospital, and theNorthwestern University Feinberg School of Medicine, Chicago, Illinois
Lance R. Peterson
Affiliation:
Departments of Pathology and Medicine, Evanston Northwestern Healthcare, Evanston, and theNorthwestern University Feinberg School of Medicine, Chicago, Illinois

Abstract

Objectives:

Investigate and control an increase in bloodstream infections (BSIs) in an outpatient hemodialysis center.

Patients and Design:

A retrospective cohort study was conducted for patients receiving dialysis at the center from February 2000 to April 2001. A case–control study compared microbiological data for all BSIs that occurred during the study period with those for BSIs that occurred during a baseline period Qanuary 1999 to January 2000). BSI rates before and after a 1-month intervention (May 2001) were assessed. A case was defined as a new BSI during the study period.

Results:

The outbreak was polymicrobial, with approximately 30 species. The baseline BSI rate was 0.7 per 100 patient-months. From February 2000 to April 2001, the BSI rate increased to 4.2 per 100 patient-months. Overall, 75% of the BSIs were associated with central venous catheters (CVCs), but CVC use did not fully explain the increase in BSIs. In January 2000, when the center changed ownership, prepackaged CVC dressing kits and biweekly infection control monitoring were discontinued. Beginning in May 2001, staff were educated on CVC care, chlorhexidine replaced povidone-iodine for cutaneous antisepsis, gauze replaced transparent dressings, antimicrobial ointments containing polyethylene glycol at CVC exit sites were discontinued, and patients with CVCs were educated on cutaneous hygiene. After the intervention period, by October 2001, rates decreased to less than 1 BSI per 100 patient-months.

Conclusions:

Proper cutaneous antisepsis and access site care is crucial in preventing BSIs in patients receiving hemodialysis. Infection control programs, staff and patient education, and use of optimal antisepsis agents or prepackaged kits are useful toward this end.

Type
Original Articles
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2002

Access options

Get access to the full version of this content by using one of the access options below.

References

1.D'Agata, EM, Mount, DB, Thayer, V, Schaffner, W. Hospital-acquired infections among chronic hemodialysis patients. Am J Kidney Dis 2000; 35:10831088.CrossRefGoogle ScholarPubMed
2.Horl, WH. Neutrophil function and infections in uremia. Am J Kidney Dis 1999;33:xlvxlvii.CrossRefGoogle Scholar
3.Sexton, DJ. Vascular access infections in patients undergoing dialysis with special emphasis on the role and treatment of Staphylococcus aureus. Infect Dis Clin North Am 2001;15:731742, vii.CrossRefGoogle ScholarPubMed
4.Task Force on Reuse of Dialyzers, Council on Dialysis, National Kidney Foundation. National Kidney Foundation report on dialyzer reuse. Am J Kidney Dis 1997;30:859871.CrossRefGoogle ScholarPubMed
5.Centers for Disease Control and Prevention. Outbreaks of gram-negative bacterial bloodstream infections traced to probable contamination of hemodialysis machines—Canada, 1995; United States, 1997; and Israel, 1997. MMWR 1998;47:5558.Google Scholar
6.Alter, MJ, Favero, MS, Miller, JK, Coleman, PJ, Bland, LA. Reuse of hemodialyzers: results of nationwide surveillance for adverse effects. JAMA 1988;260:20732076.CrossRefGoogle ScholarPubMed
7.Longfield, RN, Wortham, WG, Fletcher, LL, Nauscheutz, WF. Clustered bacteremias in a hemodialysis unit: cross-contamination of blood tubing from ultrafiltrate waste. Infect Control Hosp Epidemiol 1992;13:160164.CrossRefGoogle Scholar
8.Grohskopf, LA, Roth, VR, Feikin, DR, et al. Serratia liquefaciens bloodstream infections from contamination of epoetin alfa at a hemodialysis center. N Engl J Med 2001;344:14911497.CrossRefGoogle Scholar
9.Alfurayh, O, Sabeel, A, Al Ahdal, MN, et al. Hand contamination with hepatitis C virus in staff looking after hepatitis C-positive hemodialysis patients. Am J Nephrol 2000;20:103106.CrossRefGoogle ScholarPubMed
10.Garg, PP, Frick, KD, Diener-West, M, Powe, NR. Effect of the ownership of dialysis facilities on patients' survival and referral for transplantation. N Engl J Med 1999;341:16531660.CrossRefGoogle ScholarPubMed
11.Arnow, PM, Garcia-Houchins, S, Neagle, MB, Bova, JL, Dillon, JJ, Chou, T. An outbreak of bloodstream infections arising from hemodialysis equipment. J Infect Dis 1998;178:783791.CrossRefGoogle ScholarPubMed
12.Tokars, JI, Miller, ER, Alter, MJ, Arduino, MJ. National Surveillance of Dialysis Associated Diseases in the United States, 1999. Atlanta, GA: Centers for Disease Control and Prevention; 1999.Google Scholar
13.Peterson, LR, Brossette, SE. Hunting healthcare-associated infections from the clinical microbiology laboratory: passive, active, and virtual surveillance. J Clin Microbiol 2002;40:14.CrossRefGoogle Scholar
14.Yu, VL, Goetz, A, Wagener, M, et al. Staphylococcus aureus nasal carriage and infection in patients on hemodialysis: efficacy of antibiotic prophylaxis. N Engl J Med 1986;315:9196.CrossRefGoogle ScholarPubMed
15.Montecalvo, MA, Shay, DK, Patel, P, et al. Bloodstream infections with vancomycin-resistant enterococci. Arch Intern Med 1996;156:14581462.CrossRefGoogle ScholarPubMed
16.Smith, TL, Pearson, ML, Wilcox, KR, et al. Emergence of vancomycin resistance in Staphylococcus aureus: Glycopeptide-Intermediate Staphylococcus aureus Working Group. N Engl J Med 1999;340:493501.CrossRefGoogle ScholarPubMed
17.Stevenson, KB, Hannah, EL, Lowder, CA, et al. Epidemiology of hemodialysis vascular access infections from longitudinal infection surveillance data: predicting the impact of NKF-DOQI clinical practice guidelines for vascular access. Am J Kidney Dis 2002;39:549555.CrossRefGoogle ScholarPubMed
18.Maki, DG, Ringer, M, Alvarado, CJ. Prospective randomized trial of povidone-iodine, alcohol, and Chlorhexidine for prevention of infection associated with central venous and arterial catheters. Lancet 1991;338:339343.CrossRefGoogle ScholarPubMed
19.Conly, JM, Grieves, K, Peters, B. A prospective, randomized study comparing transparent and dry gauze dressings for central venous catheters. J Infect Dis 1989;159:310319.CrossRefGoogle ScholarPubMed
20.Hoffmann, KK, Weber, DJ, Samsa, GP, Rutala, WA. Transparent Polyurethane film as an intravenous catheter dressing: a meta-analysis of the infection risks. JAMA 1992;267:20722076.CrossRefGoogle ScholarPubMed
21.Fitchie, C. Central venous catheter-related infection and dressing type. Intensive Critical Care Nursing 1992;8:199202.CrossRefGoogle ScholarPubMed
22.National Kidney Foundation. Prevention of complications: infection. In: National Kidney Foundation. NKF-K/DOQI Clinical Practice Guidelines for Vascular Access: Update 2000. New York: National Kidney Foundation; 2002.Google ScholarPubMed
15
Cited by

Send article to Kindle

To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

An Outbreak of Bloodstream Infections in an Outpatient Hemodialysis Center
Available formats
×

Send article to Dropbox

To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

An Outbreak of Bloodstream Infections in an Outpatient Hemodialysis Center
Available formats
×

Send article to Google Drive

To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

An Outbreak of Bloodstream Infections in an Outpatient Hemodialysis Center
Available formats
×
×

Reply to: Submit a response

Please enter your response.

Your details

Please enter a valid email address.

Conflicting interests

Do you have any conflicting interests? *