Protecting patients from bloodstream infections (BSIs) should be a top priority for any dialysis clinic. Dialysis patients are at high-risk for infections as the bloodstream is being repeatedly exposed for access, and patients’ immune systems are compromised.
Dialysis patients with central lines experience an estimated 37,000 BSIs per year, with 1 in 4 of those cases resulting in death. Additionally, patients are hospitalized for infection to the tune of $23,000. Nephrology experts agree that this potentially deadly and costly BSI problem is preventable when dialysis clinics follow some important guidelines.
Follow CDC guidelines
In 2011, the Centers for Disease Control released guidelines, tools and checklists to help dialysis clinics prevent infection. And yet, the rate of infection has remained largely unchanged. Leslie P. Wong, MD, MBA, chair of Quality, Assessment, Improvement and Education for the Nephrologists Transforming Dialysis Safety (NTDS) Project, and Alan S. Kliger, MD, the chair of the project, both observed that medical directors don’t consistently emphasize the importance of infection prevention, and that the CDC guidelines have not be used as widely as needed.
Practice standard hygiene
It may sound like a no-brainer, but washing hands between patients, disinfecting surfaces, and using new gloves are the top ways to prevent BSIs. This is a surprisingly difficult rule for clinics to follow: The number of citations for improper hand hygiene and neglecting to disinfect surface equipment went up 35% and 15% respectively.
Many directors struggle with effectively managing staff. They often send unclear messages to their staff about following health protocols or fail to do so themselves. In order to make change happen, medical directors need to consistently lead by example and insist that others do the same.
On the flip side of this equation is empowering dialysis patients during their treatments. Dialysis patients often don’t speak up about breaches of protocol for fear of being labeled “non-compliant” — which can lead to mistreatment, or worse, an “involuntary discharge” from their clinic. Clinic directors must create an environment in which patients feel safe reporting neglect, mistreatment, or breaches of protocol.
Additionally, directors can educate patients on the questions and steps they can take to prevent infections themselves. Sweden, for example, goes as far as to have dialysis patients manage their own dialysis and care which has resulted in increased patient satisfaction and a 33% drop in cost due to fewer complications.
Because of monetary incentives, dialysis clinics are often under a lot of pressure to treat as many patients in a day as possible. Dialysis technicians are constantly juggling a large number of patients within unreasonable time constraints. As a result, staff are more prone to skipping important steps for infection control like properly disinfecting a dialysis station. Redesigning workflow to allow for longer treatment times will significantly alleviate pressure that leads to dangerous shortcuts.
In order to really reach a target of zero infection, dialysis clinics have to see this goal as a commitment rather than compliance. Infections that lead to patient hospitalization or death are highly preventable. When medical directors take the lead on improving BSI rates, dialysis patients will experience better care, healthcare costs will be reduced, and we’ll have a healthier population overall.