ISSUE: Catheter related Bacteremia (CRB) is an ongoing concern in the Hemodialysis Population. The Hospital outpatient unit experienced an increase in CRB rates above the Centers for Disease Control (CDC) comparative data. This prompted multifaceted and multidisciplinary interventions. These interventions resulted in a downward trend of CRB and Localized site infections but the decrease in CRB was not sustained.

PROJECT: Detailed analysis of the CDC- Dialysis Surveillance Network data for our unit from 2001 through 2005 revealed a total of 287 CRB. Sixty-seven patients (54%) experienced 80% of the infections with an average of 3.5 infections per patient (range 2-11). Subsequent infections were commonly due different organisms. Fifty-five patients (45%) had only one episode of CRB. Our analysis indicates that the likelihood of CRB is greater with a previous CRB and interventions to prevent the initial CRB might be beneficial. A plan was implemented to focus on preventing initial infections as a means to prevent subsequent infections. An Access Committee worked to promote early placement of Arterial Venous Fistulas (AVF), thereby reducing the number of tunneled catheters being placed and used as means of initial dialysis access.

RESULTS: The average percent of patients with perm catheters dropped from 48% to 26% by the end of 2005. During this same time period the number of new patients increased by 25%. A vascular awareness program was implemented for patients and staff that included decreasing the number of manipulations of the catheters, awareness of patient staff ratios, re-education of patients and continued competencies for staff.

LESSONS LEARNED: All Bacteremia are not equal and dialysis patients who experience repeated infections may require novel approaches to prevention and control of CRB. It may not be possible to eliminate or have sustained low levels of initial infections in the presence of large numbers of catheters. When analyzing dialysis Bacteremia, a case control study may be beneficial to further identify patients at risk for CRB. Early prevention strategies could then be targeted to this population.