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Multicenter Study
. 2019 Jun 18:8:105.
doi: 10.1186/s13756-019-0557-8. eCollection 2019.

Access-related infections in two haemodialysis units: results of a nine-year intervention and surveillance program

Ittamar Gork  1 , Ilana Gross  2 , Matan J Cohen  2 , Carmela Schwartz  2 , Allon E Moses  2 , Michal Dranitzki Elhalel  1 , Shmuel Benenson  2
Affiliations
Multicenter Study

Access-related infections in two haemodialysis units: results of a nine-year intervention and surveillance program

Ittamar Gork et al. Antimicrob Resist Infect Control. .

Abstract

Background: Access-related infections are a major cause of morbidity and mortality in haemodialysis patients. Our goal was to decrease the rate of these infections by implementing an intervention and surveillance program.

Methods: This intervention took place in two haemodialysis units (Units A and B) and was a joint effort by the haemodialysis staff and the unit for infection prevention and control. It included reviewing the work methods and work space, observations on compliance with standard precautions and handling of the vascular access, creating a checklist and a designated kit for handling the vascular access and prospective surveillance of access-related infections.

Results: During a nine-year period, the haemodialysis units A and B treated 4471 and 7547 patients (mean number of patients per year: 497 (range 435-556) and 839 (range 777-1055), respectively). For most patients, the procedure was done through an arteriovenous fistula (66.7%, range 50.3-81.5%). The access-related infection rate decreased significantly in both haemodialysis units: from 3 to 0.9% (trend: p < 0.05, linear regression: p < 0.001) in Unit A and from 0.9 to 0.2% (trend: p < 0.05, linear regression: p = 0.01) in Unit B.

Conclusions: An intervention which included introduction of a checklist and designated kit, together with ongoing surveillance and feedback, resulted in a significant decrease in the access-related infection rates in both haemodialysis units.

Keywords: Access-related infections; Checklist; Haemodialysis; Intervention; Surveillance.

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Conflict of interest statement

Competing interestsThe authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
a, b The proportions of patients with each mode of vascular access (tunnelled catheter, AV graft or fistula) in Unit A (a) and Unit B (b) units. Summarized proportions could exceed 100% since some patients had both a tunnelled catheter and an AV fistula or graft in the same time until the fistula or graft were fully operational
Fig. 2
Fig. 2
Annually access-related infection rates, by unit. There is a significant trend of decrease in both units (Unit A, from 3.0 to 0.9%, trend: p < 0.05, linear regression: p < 0.001; Unit B, from 0.9 to 0.2%, trend: p < 0.05, linear regression: p = 0.01)
Fig. 3
Fig. 3
a, b Annually access-related infection rates by mode of vascular access (tunnelled catheter, AV graft or fistula) and unit; Unit A (a), Unit B (b)
See this image and copyright information in PMC

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