Embracing collaboration: a novel strategy for reducing bloodstream infections in outpatient hemodialysis centers

Am J Infect Control. 2013 Jun;41(6):513-9. doi: 10.1016/j.ajic.2012.07.015. Epub 2012 Dec 7.


Background: The incidence of access-related bloodstream infections (AR-BSIs) in US outpatient hemodialysis centers is unacceptably high. This paper presents the implementation and results achieved from a multi-pronged strategy to reduce AR-BSIs in 1 outpatient hemodialysis center.

Methods: The intervention, which took place between 2009 and 2011, involved membership in the Centers for Disease Control and Prevention Hemodialysis Bloodstream Infection Prevention Collaborative, implementation of a panel of infection prevention interventions, and use of positive deviance (PD) to engage staff. Changes in the incidence of AR-BSIs and infection prevention process measures between the pre- and postintervention time periods, as well as alterations in the center's social networks, were examined to assess impact.

Results: The incidence of all AR-BSIs dropped from 2.04 per 100 patient-months preintervention to 0.75 (P = .03) after employing the Collaborative interventions and to 0.24 (P < .01) after augmenting the Collaborative interventions with PD. Adherence rates increased significantly in 4 of 5 infection prevention process measure categories. The dialysis center's social networks became more inclusive and connected after implementation of PD.

Conclusion: Participating in a Collaborative, employing a panel of infection prevention strategies, and engaging employees through PD resulted in a significant decline in AR-BSIs in this facility. Other hemodialysis facilities should consider a similar approach.

MeSH terms

  • Ambulatory Care Facilities / organization & administration*
  • Bacteremia / epidemiology*
  • Bacteremia / prevention & control*
  • Centers for Disease Control and Prevention, U.S.
  • Cooperative Behavior*
  • Guideline Adherence
  • Health Personnel / education*
  • Hemodialysis Units, Hospital / organization & administration*
  • Humans
  • Incidence
  • Infection Control / methods
  • Outpatients
  • Practice Guidelines as Topic
  • Renal Dialysis
  • United States / epidemiology
  • Vascular Access Devices / microbiology*