Infection Prevention and Control Practices Among United States Hemodialysis Facilities

Area of Science:

• Infection Prevention and Control
• Public Health
• Nephrology

Background:

• Bloodstream infections (BSIs) are a significant concern for patients undergoing hemodialysis.
• National initiatives have aimed to reduce BSI rates in this vulnerable population.
• Understanding changes in infection prevention and control (IPC) practices is crucial for evaluating these efforts.

Purpose of the Study:

• To compare facility-reported infection prevention and control (IPC) practices in US outpatient hemodialysis facilities between 2015 and 2021.
• To identify national trends and changes in IPC practices following the implementation of national BSI reduction strategies.

Main Methods:

• Utilized data from the National Healthcare Safety Network (NHSN) Outpatient Dialysis Practices Survey.
• Analyzed facility-reported IPC practices for the years 2015 and 2021.
• Calculated percentage differences for practices showing a >5% point change as potentially meaningful.

Main Results:

• Observed significant increases in the uptake of recommended catheter care practices between 2015 and 2021.
• Notable improvements included skin antisepsis with chlorhexidine and alcohol (+5.9% points) and use of antimicrobial ointment or chlorhexidine-impregnated dressings (+6.4% points).
• Increased use of alcohol for catheter hub antisepsis (+9.9% points) and chlorhexidine-impregnated catheter caps (49.3% in 2021) were also recorded.

Conclusions:

• The increased adoption of recommended IPC practices, particularly those involving chlorhexidine, may be linked to the observed decrease in BSI rates.
• Continued focus on promoting CDC-recommended catheter exit site care and maintaining high IPC practice standards is essential.