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Bloodstream Infection
Quality Improvement Activity (QIA)

Network Project Lead: Jeannette Shrift

Infections are the second leading cause of death in patients with end-stage renal disease (ESRD).  As a result, the Centers for Medicare and Medicaid (CMS) has set a 5-year to guide national health promotion and management to improve the health of all people in the United States living with ESRD: by 2023, reduce the national rate of blood stream infections in dialysis patients by 50% of the blood stream infections that occurred in 2016. The Networks’ role is to reduce the rate of blood stream infections (BSIs) by supporting NHSN, participating in the ESRD National Coordinating Center (NCC) Healthcare-Associated Infection (HAI) learning and Action Network (LAN), and assisting dialysis facilities in the implementation of the CDC Core Interventions.

BSIs are a  “… significant source of morbidity and mortality in the end-stage disease population.”1 In an article published in 2017 in the Clinical Journal of the American Society of Nephrologist demonstrated “Most bloodstream infections (63.0%) and access-related bloodstream infections (69.8%) occurred in patients with a central venous catheter.”2 The March 2011 issue of CDC Vital Signs, the National Center for Emerging and Zoonotic Infections Diseases reported there were approximately 37,000 bloodstream infections in 2008 which occurred in hemodialysis outpatients with central venous catheters (CVCs) and of those patients who had a CVC, up to 1 in 4 died. 

Quality Insight Renal Network 4 aims to support CMS’ 5-year target through the implementation of this HAI quality improvement activity (QIA). Network 4 will reduce BSI rates in targeted facilities by assisting them to implement their planned approach, utilizing the Institute for Healthcare Improvement (IHI) Model for Improvement, the Plan Do Study Act (PDSA) cycle, to execute the CDC’s Approach to BSI Prevention in Dialysis Facilities using the Core Interventions for Dialysis Bloodstream Infection (BSI) Prevention.3 

Monthly Reporting 

Presentations

BSI QIA Cohort Introduction Webinar – Held on 1/22/18 &1/24/18

Long Term Catheter (LTC) and BSI Subsets Webinar – Held on 2/7/18 & 2/8/18

NCC BSI QIA Learning and Action Network (LAN) Materials

January 29, 2018: Reducing Bloodstream Infections and Sepsis​
  • Presentation Objectives:
    • Promote implementation of the Centers for Disease Control (CDC) recommended core interventions for dialysis BSI prevention.
    • Share best practices in reducing Healthcare-Associated Infections, BSIs, and sepsis.
    • Sepsis Assessment Tool Development And Implementation Within One Dialysis Unit In The Midwest Kidney Network (ESRD Network 11).
April 3, 2018: Pathway to Hemodialysis Catheter Related Bloodstream Infection (CRBSI) Reduction​
  • Presentation Objectives:
    • Define challenges of the acute kidney injury/failure, end stage renal disease, and nursing home or long-term ambulatory care (LTAC) patient population.
    • Highlight recognized issues contributing to the increase of bloodstream infection (BSI) rates and hospitalization.
    • Identify how to improve collaboration with other healthcare providers
  • Presentation Slides
  • Recording Link
June 5, 2018: Outpatient Hemodialysis Environmental Cleaning and Disinfection August 7, 2018: Infection Prevention: Teamwork is the Key​
  • Presentation Objectives:
    • Discuss the importance of involving an interdisciplinary team, including patient representatives in infection reduction.
    • Utilize NHSN/CDC Tools for effective hand hygiene to avoid infection.
    • Share audit results from monitoring and observations to focus on what was working to eliminate infections.
  • Recording Link
October 2, 2018: A Success Story in a Long Term Catheter Project

Quality Improvement Videos and Tools

Tools and Resources for BSI Cohort & BSI Subset

Tools and Resources for Long Term Catheter (LTC) Subset

References

  1. Soi V, Moore CL, Kumbar L, Yee J. Prevention of catheter-related bloodstream infections in patients on hemodialysis: challenges and management strategies. International Journal of Nephrology and Renovascular Disease. 2016; 9:95-103. doi:10.2147/IJNRD.S76826.
  2. Nguyen DB1, Shugart A2, Lines C2 et al. National healthcare safety network (NHSN) dialysis event surveillance report for 2014. Clin J Am Soc Nephrol. 2017 Jul 7;12(7):1139-1146. doi: 10.2215/CJN.11411116. Epub 2017 Jun 29.
  3. Centers for Disease Prevention and Control. CDC approach to BSI prevention in dialysis facilities. CDC.gov. http://www.cdc.gov/dialysis/prevention-tools/core-interventions.html Last updated June 15, 2016. Accessed December 18, 2017.