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Survey of Infection Control Practices in Hemodialysis Units: Preventing Vascular Access–Associated Bloodstream Infections

Published online by Cambridge University Press:  10 May 2016

Pascale Trépanier ,
Caroline Quach ,
Milagros Gonzales ,
Élise Fortin ,
Mohammed Kaouache ,
Simon Desmeules ,
Isabelle Rocher ,
Muleka Ngenda-Muadi ,
Charles Frenette  and
Claude Tremblay
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Pascale Trépanier
Affiliation:
Infection Prevention and Control, Department of Medical Microbiology, Centre Hospitalier Universitaire (CHU) de Québec Pavillon Hôtel-Dieu de Québec, Quebec City, Quebec, Canada
Caroline Quach
Affiliation:
Infection Prevention and Control, McGill University Health Centre, Montreal, Quebec, Canada Institut National de Santé Publique du Québec, Montreal, Quebec, Canada
Milagros Gonzales
Affiliation:
Infection Prevention and Control, McGill University Health Centre, Montreal, Quebec, Canada
Élise Fortin
Affiliation:
Institut National de Santé Publique du Québec, Montreal, Quebec, Canada
Mohammed Kaouache
Affiliation:
Infection Prevention and Control, McGill University Health Centre, Montreal, Quebec, Canada
Simon Desmeules
Affiliation:
Division of Nephrology, Department of Medicine, CHU de Québec Pavillon Hôtel-Dieu de Québec, Quebec City, Quebec, Canada
Isabelle Rocher
Affiliation:
Institut National de Santé Publique du Québec, Montreal, Quebec, Canada
Muleka Ngenda-Muadi
Affiliation:
Institut National de Santé Publique du Québec, Montreal, Quebec, Canada
Charles Frenette
Affiliation:
Infection Prevention and Control, McGill University Health Centre, Montreal, Quebec, Canada Institut National de Santé Publique du Québec, Montreal, Quebec, Canada
Claude Tremblay*
Affiliation:
Infection Prevention and Control, Department of Medical Microbiology, Centre Hospitalier Universitaire (CHU) de Québec Pavillon Hôtel-Dieu de Québec, Quebec City, Quebec, Canada Institut National de Santé Publique du Québec, Montreal, Quebec, Canada
*
Pavillon Hôtel-Dieu de Québec, Centre Hospitalier Universitaire de Québec, 11 Côte du Palais, Quebec City, Quebec G1R 2J6, Canada (claude.tremblay@chuq.qc.ca).
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Extract

Objective

Despite surveillance, the Quebec Healthcare-Associated Infections Surveillance Program saw no improvement in vascular access–associated bloodstream infections in hemodialysis (HD). We aimed to determine the infection control measures recommended and implemented in Quebec’s HD units, compliance of local protocols to infection control practice guidelines, and reasons behind the low prevalence of arteriovenous fistulas.

Methods

An online survey was elaborated on the basis of the Centers for Disease Control and Prevention (CDC) and National Kidney Foundation Kidney Disease Outcomes Quality Initiative guidelines. The questionnaire was validated (construct, content, face validity, and reliability) and sent to all HD units in Quebec (n = 40). Results were analyzed using descriptive statistics, linear regression, and Poisson regression.

Results

Thirty-seven (93%) of 40 HD units participated. Thirty (94%) of the 32 centers where central catheters are inserted have written insertion protocols. Compliance with practice guidelines is good, except for full-body draping during catheter insertion (79%) and ointment use at insertion site (3%). Prevention measures for catheter maintenance are in accordance with guidelines, except for skin disinfection with at least 0.5% chlorhexidine and 70% alcohol (67% compliance) and regular antiseptic ointment use at the insertion site (3%). Before fistula cannulation, skin preparation is suboptimal; forearm hygiene is performed in only 61% of cases. Several factors explain the low rate of fistulas, including patient preference (69%) and lack of surgical resources (39%; P = .01).

Conclusions

Improvement in standardization of care according to practice guidelines is necessary. Fistula rate could be increased by improving access to surgical resources and patient education. Strategies are now being elaborated to address these findings.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 35 , Issue 7 , July 2014 , pp. 833 - 838
Copyright
© 2014 by The Society for Healthcare Epidemiology of America. All rights reserved.

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References

1. Centers for Disease Control and Prevention. Recommendations for preventing transmission of infections among chronic hemodialysis patients. MMWR Recomm Rep 2001;50(RR-5):1–43.Google Scholar
2. Tremblay, C, Fortin, E, Rocher, I, Trudeau, M; Surveillance Provinciale des Infections Nosocomiales. Surveillance des Bactériémies Nosocomiales Associées aux Accès Veineux en Hémodialyse Avril 2012–Mars 2013. Quebec, Canada: Institut National de Santé Publique du Québec, 2014.Google Scholar
3. Tremblay, C, Fortin, E, Rocher, I, Trudeau, M; Surveillance Provinciale des Infections Nosocomiales. Surveillance des Bactériémies Nosocomiales Associées aux Accès Veineux en Hémodialyse Avril 2011–Mars 2012. Quebec, Canada: Institut National de Santé Publique du Québec, 2012.Google Scholar
4. Health Protection Scotland. Infection control bundles. http://www.hps.scot.nhs.uk/haiic/ic/bundles.aspx. Accessed October 10, 2013.Google Scholar
5. Fistula First. Arteriovenous fistula first: the first choice for hemodialysis. http://fistulafirst.org. Accessed September 9, 2011.Google Scholar
6. Tremblay, C, Fortin, E, Rocher, I, Trudeau, M; Surveillance Provinciale des Infections Nosocomiales. Surveillance des Bactériémies Nosocomiales Associées aux Accès Veineux en Hémodialyse Avril 2010–Mars 2011. Quebec, Canada: Institut National de Santé Publique du Québec, 2012.Google Scholar
7. Fortin, E, Rocher, I, Frenette, C, Tremblay, C, Quach, C. Healthcare-associated bloodstream infections secondary to a urinary focus: the Québec provincial surveillance results. Infect Control Hosp Epidemiol 2012;33(5):456–462.Google Scholar
8. Fontela, PS, Platt, RW, Rocher, I, et al. Surveillance Provinciale des Infections Nosocomiales (SPIN) program: implementation of a mandatory surveillance program for central line-associated bloodstream infections. Am J Infect Control 2011;39(4):329–335.Google Scholar
9. Horan, TC, Andrus, M, Dudeck, MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 2008;36(5):309–322.Google Scholar
10. O’Grady, NP, Alexander, M, Burns, LA, et al. Summary of recommendations: guidelines for the prevention of intravascular catheter-related infections. Clin Infect Dis 2011;52(9):1087–1099.Google Scholar
11. Clinical practice guidelines for hemodialysis adequacy, update 2006. Am J Kidney Dis 2006;48(suppl 1):S2–S90.Google Scholar
12. Clinical practice guidelines for vascular access. Am J Kidney Dis 2006;48(suppl 1):S176–S247.Google Scholar
13. Safer Healthcare Now! http://www.saferhealthcarenow.ca/en/pages/default.aspx. Accessed September 9, 2011.Google Scholar
14. Patel, PR, Kallen, AJ, Arduino, MJ. Epidemiology, surveillance, and prevention of bloodstream infections in hemodialysis patients. Am J Kidney Dis 2010;56(3):566–577.CrossRefGoogle ScholarPubMed
15. Institute National de Santé Publique Québec. Surveillance Provinciale des Infections Nosocomiales: hémodialyse 2012. http://www.inspq.qc.ca/aspx/fr/spin.aspx?sortcode=1.53.54.61.61.63. Accessed January 30, 2012.Google Scholar
16. Centers for Disease Control and Prevention (CDC). Dialysis Bloodstream Infection Prevention Collaborative. 2012. http://www.cdc.gov/dialysis/provider/index.html. Accessed June 15, 2013.Google Scholar
17. Chow, J, Rayment, G, Miguel, SS, Gilbert, M. A randomised controlled trial of buttonhole cannulation for the prevention of fistula access complications. J Renal Care 2011;37(2):85–93.Google Scholar
18. Grudzinski, A, Mendelssohn, D, Pierratos, A, Nesrallah, G. A systematic review of buttonhole cannulation practices and outcomes. Semin Dial 2013;26(4):465–475.Google Scholar
19. Guerin, K, Wagner, J, Rains, K, Bessesen, M. Reduction in central line-associated bloodstream infections by implementation of a postinsertion care bundle. Am J Infect Control 2010;38(6):430–433.Google Scholar
20. Pronovost, P, Needham, D, Berenholtz, S, et al. An intervention to decrease catheter-related bloodstream infections in the ICU. New Engl J Med 2006;355(26):2725–2732.Google Scholar
21. Boyce, JM. Prevention of central line–associated bloodstream infections in hemodialysis patients. Infect Control Hosp Epidemiol 2012;33(9):936–944.Google Scholar
22. Patel, PR, Yi, SH, Booth, S, et al. Bloodstream infection Rates in outpatient hemodialysis facilities participating in a collaborative prevention effort: a quality improvement report. Am J Kidney Dis 2013;62(2):322–330.Google Scholar
23. Lafrance, JP, Rahme, E, Lelorier, J, Iqbal, S. Vascular access-related infections: definitions, incidence rates, and risk factors. Am J Kidney Dis 2008;52(5):982–993.Google Scholar