CDC issued a press release May 13, 2013 titled “Following CDC Protocols Cuts Dialysis Bloodstream Infections in Half.” (Click here to view CDC Press Release on Dialysis Protocols 5-13-2013 hear at Dialysis Lawsuit or click here to view the press release on the CDC website.) The press release summarized the findings of a study of 17 outpatient dialysis facilities and compared infection rates before and after a set of CDC interventions were consistently used. The study was published in the American Journal of Kidney Diseases. Among other things of interest to people who are undergoing dialysis (and their family members), consider: The shocking title of the press release that says half of all bloodstream infections would be eliminated if only the dialysis centers would follow CDC protocols; The statement by CDC Director Tom Frieden, M.D., M.P.H., who said, “These infections are preventable. CDC has simple tools that dialysis facilities can use to help ensure patients have access to the safe healthcare they deserve.” The fact that the CDC protocols do not impose costly improvements to dialysis clinics, but on things such as: “hand hygiene…” This seems to be saying, “dialysis center employees, wash your hands, wash them well, and wash them between every patient.” applying an antiseptic to the skin for catheter exit-site care. The CDC press release also stated: ”About 8 in 10 of these patients start treatment with a central line, which is a tube that a doctor usually places in a large vein in a patient’s neck or chest to give important medical treatment. When not put in correctly or not kept clean, central lines can provide a portal for germs to enter the body and cause bloodstream infections. As a result of the study, dialysis centers received a simple CDC checklist for dialysis centers. The checklist is a PDF file that will be uploaded on Michael J. Evans' SlideShare network The checklist contains things such as: Check that there is no visible soil or blood on surfaces; Ensure that the patient has left the dialysis station; Discard all single-use supplies; Remove gloves and perform hand hygiene; Wear clean gloves. There are more items on the checklist, but most are common sense items such as the ones listed above. Did half the dialysis patients who got blood infections before the CDC press release get the infections simply because the dialysis center employees didn’t follow proper hygiene? How many hospitalizations for bloodstream infections and how many dialysis deaths could have been prevented? It would seem to be reasonable to conclude from the CDC documents that half of all bloodstream infections are due to poor medical hygiene. Read the documents for yourself. And if you or your family member is a patient at an outpatient dialysis center, it might not be a bad idea to print out a copy of the CDC Checklist and take it with you the next time you go to the dialysis center.

1. Press Release
For Immediate Release: Monday, May 13, 2013
Contact: CDC Division of PublicAffairs (http://www.cdc.gov/media/index.html)
(404) 639-3286
Following CDC Protocols Cuts Dialysis Bloodstream Infections
in Half
CDC provides tools to help all U.S. dialysis facilities reduce potentially deadly infections
Today, the Centers for Disease Control and Prevention (CDC) released results of its Dialysis
Bloodstream Infection Prevention Collaborative (http://www.cdc.gov/dialysis/collaborative/)
showing a 32 percent decrease in overall bloodstream infections and a 54 percent decrease in
vascular access-related bloodstream infections after CDC prevention guidelines were used.
Vascular access-related bloodstream infections are those related to devices used to access the
bloodstream for hemodialysis. With approximately 37,000 bloodstream infections occurring
each year among dialysis patients with central lines, at an estimated cost of $23,000 per
hospitalization, wider implementation of the practices in this study (http://www.cdc.gov/dialysis
/prevention-tools/core-interventions.html) could help save lives and reduce excess health care
spending.
Published in the American Journal of Kidney Diseases (http://www.ajkd.org/)
(http://www.cdc.gov/Other/disclaimer.html) , the study looked at data reported to the National
Healthcare Safety Network (http://www.cdc.gov/nhsn/dialysis/index.html) (NHSN) by 17
outpatient dialysis facilities and compared infection rates before and after a set of CDC
interventions were consistently used. Interventions included chlorhexidine (an antiseptic for
the skin) for catheter exit-site care, staff training and competency assessments focused on
catheter care and aseptic technique, hand hygiene and vascular access care audits, and
feedback of infection and adherence rates to staff. Facility staff were also encouraged to use
antimicrobial ointment on central line exit sites.
"Dialysis patients often have multiple health concerns, and the last thing they need is a
bloodstream infection from dialysis,” said CDC Director Tom Frieden, M.D., M.P.H. “These
infections are preventable. CDC has simple tools that dialysis facilities can use to help ensure
patients have access to the safe healthcare they deserve.”
In 2010, more than 380,000 patients in the United States relied on hemodialysis for treatment
of their end-stage kidney disease. About 8 in 10 of these patients start treatment with a central
line, which is a tube that a doctor usually places in a large vein in a patient’s neck or chest to
give important medical treatment. When not put in correctly or not kept clean, central lines
can provide a portal for germs to enter the body and cause bloodstream infections. Other forms
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2. of vascular access used for hemodialysis, such as arteriovenous fistulas and grafts, can also put
patients at risk for bloodstream infections, but to a lesser extent than central lines.
Although the overall rate of hospitalization among hemodialysis patients has remained
relatively stable since 1993, the rate of hospitalization for bloodstream infections has increased
51 percent. A dialysis patient is more than 100 times more likely to get a bloodstream infection
from a common resistant bacteria, methicillin-resistant Staphylococcus aureus, than other
people. Infections with Staphylococcus aureus can be potentially devastating and can result in
hospitalization, death, and serious complications such as endocarditis (heart infection) and
osteomyelitis (bone infection).
To address this critical public health issue, CDC launched a collaborative project in April 2009
to prevent bloodstream infections among dialysis patients and invited outpatient dialysis
centers to participate. CDC and the participating dialysis centers worked together to develop
and implement the package of interventions to prevent bloodstream infections. The dialysis
facilities tracked bloodstream infections in their patients using CDC’s National Healthcare
Safety Network (http://www.cdc.gov/nhsn/dialysis/index.html) (NHSN), which is now being used
by over 5,000 dialysis facilities nationwide for tracking and prevention of healthcare-
associated infections.
“Dialysis patients are particularly vulnerable to infections,” said Dr. Priti Patel, head of CDC’s
dialysis safety efforts. “We now know it is possible to significantly reduce the infections among
dialysis patients by following CDC’s checklists and tools. If all dialysis facilities nationwide
were using the CDC interventions, we could see dramatic reductions in infections and adverse
outcomes in this population.”
Dialysis facilities can implement many of CDC’s recommendations by using a series of
checklist (http://www.cdc.gov/dialysis/PDFs/collaborative/checklist-Portfolio.pdf) s and
performing observations using audit tools (http://www.cdc.gov/dialysis/PDFs/collaborative
/audit-tools-Portfolio2.pdf) that are currently available on CDC’s website. Additionally, CDC has
released a free infection prevention course (http://www.cdc.gov/dialysis/clinician/CE/infection-
prevent-outpatient-hemo.html) for dialysis nurses and technicians that reviews CDC
recommended practices in a convenient, 1-hour self-guided internet training course that also
offers continuing education credits.
Preventing bloodstream infections among dialysis patients has been identified as a national
priority (http://www.hhs.gov/ash/initiatives/hai/esrd.html) (http://www.cdc.gov/Other
/disclaimer.html) by the U.S. Department of Health and Human Services (http://www.hhs.gov/)
(http://www.cdc.gov/Other/disclaimer.html) . Several initiatives have demonstrated the ability
to reduce bloodstream infections in hospital intensive care units, but prior to the CDC Dialysis
Bloodstream Infection Prevention Collaborative, there have been few similar initiatives
attempted in outpatient settings.
For more information on what CDC is doing to make dialysis safer for patients, please see:
www.cdc.gov/dialysis (http://www.cdc.gov/dialysis) .
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3. Page last reviewed: May 15, 2013
Page last updated: May 15, 2013
Content source: Centers for Disease Control and Prevention
Centers for Disease Control and Prevention 1600 Clifton Rd. Atlanta, GA
30333, USA
800-CDC-INFO (800-232-4636) TTY: (888) 232-6348 - Contact CDC–INFO
For more information about the study, visit: http://www.sciencedirect.com/science/article
/pii/S0272638613006677 (http://www.sciencedirect.com/science/article/pii/S0272638613006677)
(http://www.cdc.gov/Other/disclaimer.html) .
To access CDC’s dialysis infection prevention tools, see: http://www.cdc.gov/dialysis
/prevention-tools/index.html (http://www.cdc.gov/dialysis/prevention-tools/index.html) .
###
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES (http://www.hhs.gov/)
(http://www.cdc.gov/Other/disclaimer.html)
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