Central Line-Associated Bloodstream Infection Reduction in Hemodialysis Patients Across 9 Hospitals and 3 States

This quality improvement project was initiated to reduce hospital-acquired catheter-associated bloodstream infections (CLABSI) in hospitalized patients receiving dialysis. A team dedicated to reducing hospital-acquired infections led the implementation of evidence-based interventions across all the included hospitals. This innovative approach demonstrated substantial enhancements in outcomes for patients on hemodialysis.

To enhance patient safety in patients receiving hemodialysis, new strategies were implemented, including (1) transitioning from a vendor model to an internal model, enabling dialysis program standardization, (2) empowering intensive care nurses with increased autonomy and ownership, (3) transitioning to a standardized dialysis machine, and (4) introducing chlorhexidine gluconate (CHG) impregnated caps and CHG pads. To reduce CLABSI in hemodialysis lines, a multidisciplinary team was formed comprising physicians, nurses, a dialysis technician, pharmacists, the dialysis director, the chief medical officer, the chief nursing officer, the assistant chief nursing officer, the infection preventionist, and the quality director. The team implemented a standardized approach to caring for hemodialysis lines, provided just-in-time education to staff, and standardized policies simultaneously at 8 hospitals. Initially, 1 facility served as the pilot facility for facility-owned dialysis services, totaling 9 facilities providing in-house standardized dialysis services. Data was reported back for monthly evaluation.

Overall, there was an 88% reduction in CLABSI occurrences in hemodialysis lines from pre-intervention (n = 8) to post-intervention (n = 1), X² (1, N = 4112) = 4.181, P = .0408. Collaboration on these initiatives improved communication and enhanced quality care and patient safety across the entire spectrum of care.

Implementing innovative tracking of standardized approaches to patient care and infection prevention and evidence-based interventions resulted in decreased CLABSI rates, improving outcomes in vulnerable patients. An unintended benefit of this project was the increase in multidisciplinary collaboration.