Hostname: page-component-78c5997874-v9fdk Total loading time: 0 Render date: 2024-11-15T06:43:32.539Z Has data issue: false hasContentIssue false
  • English
  • Français

Outbreak of Hemodialysis Vascular Access Site Infections Related to Malfunctioning Permanent Tunneled Catheters: Making the Case for Active Infection Surveillance

Published online by Cambridge University Press:  02 January 2015

Elizabeth L. Hannah ,
Kurt B. Stevenson ,
Connie A. Lowder ,
Michael J. Adcox ,
Robert L. Davidson ,
Michael C. Mallea ,
Nagraj Narasimhan  and
Jon P. Wagnild
Elizabeth L. Hannah*
Affiliation:
PRO-West, Saint Alphonsus Nephrology Center and Idaho Nephrology Associates, LLC, Boise, Idaho
Kurt B. Stevenson
Affiliation:
PRO-West, Saint Alphonsus Nephrology Center and Idaho Nephrology Associates, LLC, Boise, Idaho
Connie A. Lowder
Affiliation:
PRO-West, Saint Alphonsus Nephrology Center and Idaho Nephrology Associates, LLC, Boise, Idaho
Michael J. Adcox
Affiliation:
Saint Alphonsus Nephrology Center and Idaho Nephrology Associates, LLC, Boise, Idaho
Robert L. Davidson
Affiliation:
Saint Alphonsus Nephrology Center and Idaho Nephrology Associates, LLC, Boise, Idaho
Michael C. Mallea
Affiliation:
Saint Alphonsus Nephrology Center and Idaho Nephrology Associates, LLC, Boise, Idaho
Nagraj Narasimhan
Affiliation:
Saint Alphonsus Nephrology Center and Idaho Nephrology Associates, LLC, Boise, Idaho
Jon P. Wagnild
Affiliation:
Saint Alphonsus Nephrology Center and Idaho Nephrology Associates, LLC, Boise, Idaho
*
PRO-West, 720 Park Boulevard, Suite 120, Boise, ID 83712-7756
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To describe an outbreak of infections with permanent cuffed hemodialysis catheters recognized through ongoing surveillance and related to a specific malfunctioning permanent catheter.

Design:

The outbreak was suspected from the results of prospective infection surveillance and confirmed by a retrospective cohort study using medical records for patients receiving dialysis between April 1,1999, and March 31, 2000.

Setting:

Integrated network of six outpatient hemodialysis facilities in southern Idaho and eastern Oregon.

Patients:

Outpatients receiving long-term hemodialysis.

Results:

During the 18 months prior to the outbreak, the overall infection rate was 4.1 infections per 1,000 dialysis sessions with a catheter rate of 8.9 per 1,000 dialysis sessions. During the 7 months of the outbreak, the overall rate increased to 5.8 per 1,000 dialysis sessions, whereas the catheter rate increased to 18.1 per 1,000 dialysis sessions. Reports of malfunctioning “Brand A” catheters prompted discontinuation of their placement. A manufacturer recall occurred in April 2000. During the 14 months after the outbreak, the overall infection rate decreased to 3.3 per 1,000 dialysis sessions and the catheter rate to 10.8 per 1,000 dialysis sessions. A 12-month retrospective cohort study recognized 96 patients with an identifiable catheter brand and 48 infections. Of these, 27 (56%) occurred in patients with Brand A catheters. The relative risk for infection when compared with other catheter brands was 1.96 (95% confidence interval, 1.32 to 2.92; P < .001).

Conclusions:

Ongoing infection surveillance in hemodialysis facilities can identify specific device-related outbreaks of infections and promote interventions to reduce infectious complications and promote patient safety. Surveillance for vascular access site infections is recommended as a routine activity in hemodialysis facilities.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 23 , Issue 9 , September 2002 , pp. 538 - 541
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. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Kherlakian, GM, Roedersheimer, LR, Arbaugh, JJ, Newmark, KJ, King, LR. Comparison of autogenous fistula versus expanded polytetrafluoroethylene graft fistula for angioaccess in hemodialysis. Am J Surg 1986; 152:238–243.CrossRefGoogle ScholarPubMed
2.Dunlop, MG, Mackinlay, JY, Jenkins, AM. Vascular access: experience with the brachiocephalic fistula. Ann R Coll Surg Engl 1986;68:203–206.Google ScholarPubMed
3.Nazzal, MMS, Neglen, P, Naseem, J, Christenson, JT, al-Hassan, HK. The brachiocephalic fistula: a successful secondary vascular access procedure. Vasa 1990;19:326–329.Google ScholarPubMed
4.Suhocki, P, Conlon, PJ, Knelson, M, Harland, RC, Schwab, SJ. Silastic cuffed catheters for hemodialysis vascular access: thrombolytic and mechanical correction of malfunction. Am J Kidney Dis 1996;28:379–386.CrossRefGoogle ScholarPubMed
5.Institute of Medicine. To Err is Human: Building a Safer Health System. Washington, DC: National Academy Press; 2000.Google Scholar
6.Nolan, TW. System changes to improve patient safety. BMJ 2000;320:771–773.CrossRefGoogle ScholarPubMed
7.Diamond, LH. Patient safety: the challenges and opportunities for the ESRD program. Adv Ren Replace Ther 2000;7(suppl 1):S100–S104.Google ScholarPubMed
8.Stevenson, KB, Adcox, MJ, Mallea, MC, Narasimhan, N, Wagnild, JP. Standardized surveillance of hemodialysis vascular access infections: 18-month experience at an outpatient, multifacility hemodialysis center. Infect Control Hosp Epidemiol 2000;21:200–203.CrossRefGoogle ScholarPubMed
9.Tokars, JI. Description of a new surveillance system for bloodstream and vascular access infections in outpatient hemodialysis centers. Semin Dial 2000;13:97–100.CrossRefGoogle ScholarPubMed
10.Garner, JS, Jarvis, WR, Emori, TG, Horan, TC, Hughes, JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control 1988;16:128–140.CrossRefGoogle ScholarPubMed
11.Gaynes, RP, Culver, DH, Emori, TG, et al. The National Nosocomial Infections Surveillance System: plans for the 1990s and beyond. Am J Med 1991;91(suppl 3B):116s–120s.CrossRefGoogle Scholar
12.Taylor, G, McKenzie, M, Buchanan-Chell, M, Caballo, L, Chui, L, Kowalewska-Grochowska, K. Central venous catheters as a source of hemodialysis-related bacteremia. Infect Control Hosp Epidemiol 1998; 19:643–646.CrossRefGoogle ScholarPubMed
13.Jansen, B, Peters, G. Foreign body associated infection. J Antimicrob Chemother 1993;32(suppl A):69–75.CrossRefGoogle ScholarPubMed
14.Lew, DP, Pettit, D, Waldvogel, FA. Infections that complicate the insertion of prosthetic devices. In: Mayhall, CG, ed. Hospital Infection and Infection Control, 2nd ed. Philadelphia: Lippincott, Williams, and Wilkins; 1999.Google Scholar
15.Nelson, EC, Splaine, ME, Godfrey, MM, et al. Using data to improve medical practice by measuring processes and outcomes of care. Jt Comm J Qual Improv 2000;26:667–685.Google ScholarPubMed
16.Pearson, ML. Guideline for prevention of intravascular device-related infections: Part 1. Intravascular device-related infections: an overview. Am J Infect Control 1996;24:262–293.Google Scholar
17.National Kidney Foundation. Dialysis outcomes quality initiative: clinical practice guidelines. Am J Kidney Dis 1997;30:S137–S240.Google Scholar
18.Alter, MJ, Lyeria, RL, Tokars, JI, Miller, E, Arduino, MJ. Recommendations for preventing transmission of infections among chronic hemodialysis patients. MMWR 2001;50:1–43.Google Scholar
19.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; 2000. Available at www.cdc.gov/ncidod/hip/Dialysis/dialysis.htm.Google Scholar