Creating a Statewide Assessment and Support Service to Prevent Infections in Patients Receiving Hemodialysis

Patients who receive hemodialysis are at higher risk of developing health care-associated infections due to multiple factors, including direct and recurrent access to the bloodstream. Therefore, an effective infection prevention program should be in place to decrease the likelihood of these infections. Failure to assess gaps in systems and processes impedes the implementation of quality and performance improvement initiatives.

A multidisciplinary team created an infection prevention dialysis evaluation program by using Six Sigma's Define-Measure-Analyze-Design-Verify model. These elements included content within the dialysis-specific Infection Control Assessment and Response Tool from the Centers for Disease Control and Prevention with supporting program assessment items. From August 2021 through August 2022, the team completed 17 inpatient dialysis assessments within the cohort's 17 facilities (long-term and acute care hospitals). Data were analyzed using descriptive statistical analysis, and the final analysis included 1,086 observations from the developed assessment tool.

Deficiencies were grouped into seven major infection prevention categories among the 17 assessments, with the highest number of deficiencies seen within the categories of cleaning and disinfection (100%), hand hygiene (52.9%), and personal protective equipment (PPE) use (52.9%).

Our program was successful at detecting gaps in dialysis-based infection prevention. By conducting data analysis of assessment findings, we can assist organizations in establishing priorities for quality and performance improvement.