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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 


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

Quality Improvement Videos and Tools

Tools and Resources for BSI Cohort & BSI Subset

Tools and Resources for Long Term Catheter (LTC) Subset


  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. Last updated June 15, 2016. Accessed December 18, 2017.