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Standardized Surveillance of Hemodialysis Vascular Access Infections 18-Month Experience at an Outpatient, Multifacility Hemodialysis Center

Published online by Cambridge University Press:  02 January 2015

Kurt B. Stevenson ,
Michael J. Adcox ,
Michael C. Mallea ,
Nagraj Narasimhan  and
Jon P. Wagnild
Kurt B. Stevenson*
Affiliation:
Intermountain Infection Control, Boise, Idaho Saint Alphonsus Nephrology Center, Boise, Idaho
Michael J. Adcox
Affiliation:
Saint Alphonsus Nephrology Center, Boise, Idaho Idaho Nephrology Associates, LLC, Boise, Idaho
Michael C. Mallea
Affiliation:
Saint Alphonsus Nephrology Center, Boise, Idaho Idaho Nephrology Associates, LLC, Boise, Idaho
Nagraj Narasimhan
Affiliation:
Saint Alphonsus Nephrology Center, Boise, Idaho Idaho Nephrology Associates, LLC, Boise, Idaho
Jon P. Wagnild
Affiliation:
Saint Alphonsus Nephrology Center, Boise, Idaho Idaho Nephrology Associates, LLC, Boise, Idaho
*
Intermountain Infection Control, 777 N Raymond, Boise, ID 83704
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Abstract

Objective:

To develop a standardized surveillance system for monitoring hemodialysis vascular-access infections in order to compare infection rates between outpatient sites and to assess the effectiveness of infection control interventions.

Design:

Prospective descriptive analysis of incidence infection rates.

Setting:

An outpatient hemodialysis center with facilities in Idaho and Oregon.

Patients:

All outpatients receiving chronic outpatient hemodialysis.

Results:

There were 38,096 hemodialysis sessions (31,603 via permanent fistulae or grafts, 5,060 via permanent tunneled central catheters, and 1,433 via temporary catheters) during an 18-month study period in 1997 to 1998. We identified 176 total infections, for a rate of 4.62/1,000 dialysis sessions (ds). Of the 176, 80 involved permanent fistulae or grafts (2.53/1,000 ds), 69 involved permanent tunneled central catheter infections (13.64/1,000 ds), and 27 involved temporary catheter infections (18.84/1,000 ds). There were 35 bloodstream infections (0.92/1,000 ds) and 10 episodes of clinical sepsis (0.26 /1,000 ds). One hundred thirty-one vascular-site infections without bacteremia were identified (3.44/1,000 ds), including 65 permanent fistulae or graft infections (2.06/1,000 ds), 42 permanent tunneled central catheter infections (8.3/1,000 ds), and 24 temporary catheter infections (16.75/1,000 ds).

Conclusions:

Infection rates were highest among temporary catheters and lowest among permanent native arteriovenous fistulae or synthetic grafts. This represents the first report of extensive incidence data on hemodialysis vascular access infections and represents a standardized surveillance and data-collection system that could be implemented in hemodialysis facilities to allow for reliable data comparison and benchmarking.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 21 , Issue 3 , March 2000 , pp. 200 - 203
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2000

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References

1.Zibari, GB, Rohr, MS, Landreneau, MD, Bridges, RM, DeVault, GA, Petty, FH, et al. Complications from permanent hemodialysis vascular access. Surgery 1988;104:681–686.Google Scholar
2.Feldman, HI, Held, PJ, Hutchinson, JT, Stoiber, E, Hartigan, MF, Berlin, JA. Hemodialysis vascular access morbidity in the United States. Kidney Int 1993;43:1091–1096.Google Scholar
3.US Renal Data Systems. Causes of death. Am J Kidney Dis 1995;26(suppl):S93–S102.Google Scholar
4.Pearson, ML, the Hospital Infection Control Practices Advisory Committee. Guideline for prevention of intravascular device-related infections. Infect Control Hosp Epidemiol 1996;17:438–473.Google ScholarPubMed
5.National Kidney Foundation. Dialysis outcomes quality initiative. Clinical practice guidelines. Am J Kidney Dis 1997;30(suppl):S137–S240.Google Scholar
6.Haley, RW, Culver, DH, White, JW. The efficacy of infection surveillance and control programs in preventing nosocomial infections in US hospitals. Am J Epidemiol 1985;121:182–205.CrossRefGoogle ScholarPubMed
7.Kherlakian, GM, Roedersheimer, LR, Arbaugh, JJ, Newmark, KJ, King, LR. Comparison of autogenous fistula versus expanded polytetrafluoroethylene graft fistula for angioaccess in hemodialysis. Am J Surg 1986;152:238–243.Google Scholar
8.Dunlop, MG, Mackinlay, JY, Jenkins, AM. Vascular access: experience with the brachiocephalic fistula. Ann R Coll Surg Engl 1986;68:203–206.Google ScholarPubMed
9.Nazzal, MM, Neglen, P, Naseem, J, Christenson, JT, Al-Hassan, HKThe brachiocephalic fistula: a successful secondary vascular access procedure. Vasa 1990;19:326–329.Google ScholarPubMed
10.Raju, S. PTFE grafts for hemodialysis access: techniques for insertion and management of complications. Ann Surg 1987;206:666–673.Google Scholar
11.Anderson, CB, Sicard, GA, Etheredge, EE. Bovine carotid artery and expanded polytetrafluoroethylene grafts for hemodialysis vascular access. J Surg Res 1980;29:184–188.Google Scholar
12.Rizzuti, RP, Hale, JC, Burkart, TE. Expanded patency of expanded polytetrafluoroethylene grafts for vascular access using optimal configuration and revisions. Surg Gynecol Obstet 1988;166:23–27.Google Scholar
13.Lilly, L, Nighiem, D, Mendez-Picon, G, Lee, HM. Comparison between bovine heterograft and expanded PTFE grafts for dialysis access. Am Surg 1980;46:694–696.Google Scholar
14.Bhat, DJ, Tettis, VA, Kohlberg, WI, Driscoll, B, Veith, FJ. Management of sepsis involving expanded polytetrafluoroethylene grafts for hemodialysis access. Surgery 1980;87:445–450.Google Scholar
15.Odurny, A, Slapak, M. The use of Goretex (P.T.F.E.) for angic-access for chronic hemodialysis: the place of peri-operative antibiotics. Br J Clin Prac 1984;38:134–137.CrossRefGoogle ScholarPubMed
16.Suchoki, R, Conlon, PJ, Knelson, M, Harland, RC, Schwab, SJ. Silastic cuffed catheters for hemodialysis vascular access: thrombolytic and mechanical correction of HD catheters malfunction. Am J Kidney Dis 1996;28:379–386.Google Scholar
17.Marr, KA, Sexton, DJ, Conlon, PJ, Corey, GR, Schwab, SJ, Kirkland, KB. Catheter-related bacteremia and outcome of attempted catheter salvage in patients undergoing hemodialysis. Ann Intern Med 1997;127:275–280.Google Scholar
18.Vanholder, R, Hoenich, N, Ringoir, S. Morbidity and mortality of central venous catheter hemodialysis: a review of 10 years experience. Nephron 1987;47:274–279.Google Scholar
19.Garner, JS, Jarvis, WR, Emori, TG, Horan, TC, Hughes, JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control 1988;16:28–40.Google Scholar
20.Gaynes, RP, Culver, DH, Emori, TG, Horan, TC, Banerjee, SN, Edwards, JR, et al. The National Nosocomial Infections Surveillance System: plans for the 1990s and beyond. Am J Med 1991;91(suppl 3B):116S–120S.CrossRefGoogle ScholarPubMed
21.Cintron, F. Initial processing, inoculation, and incubation of aerobic bacteriology specimens. In: Isenberg, HD, ed. Clinical Microbiology Procedures Handbook. Washington, DC: American Society for Microbiology; 1994:1.4.1–1.4.19.Google Scholar
22.Maki, DG, Weise, CE, Sarafin, HW. A semi-quantitative method for identifying intravenous catheter infection. N Engl J Med 1977;296:1305–1309.Google Scholar
23.Almon, R, Pezzlo, M. Processing and interpretation of blood cultures. In: Isenberg, HD, ed. Clinical Microbiology Procedures Handbook. Washington, DC: American Society for Microbiology; 1994:1.7.1–1.7.11.Google Scholar
24.US Renal Data Systems. USRDS 1996 Annual Data Report. Bethesda, MD: National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases; 1996.Google Scholar
25.Hoen, B, Paul-Daupin, A, Hestin, D, Kessler, M. EPBACDIAL: a multicenter prospective study of risk factors for bacteremia in chronic hemodialysis patients. J Am Soc Nephrol 1998;9:869«76.Google Scholar
26.Bonomo, RA, Rice, D, Whalen, C, Linn, D, Eckstein, E, Shales, DM. Risk factors associated with permanent access-site infections in chronic hemodialysis patients. Infect Control Hosp Epidemiol 1997;18:757–761.CrossRefGoogle ScholarPubMed
27.Cheesebrough, JS, Finch, RG, Burden, RP. A prospective study of the mechanisms of infection associated with hemodialysis catheters. J Infect Dis 1986;154:579–589.Google Scholar
28.Pezzarossi, HE, Ponce de Leon, RS, Calva, JJ, Lazo de la Vega, SA, Ruiz-Palacios, GM. High incidence of subclavian dialysis catheter-related bacteremias. Infect Control 1986;7:596–599.Google Scholar
29.Keane, WF, Shapiro, FL, Raij, L. Incidence and type of infection occurring in 445 chronic hemodialysis patients. Trans Am Soc Artif Intern Organs 1977;23:41–47.Google Scholar
30.Kong, NC, Morad, Z, Suleiman, AB. Subclavian catheters as temporary vascular access. Singapore Med J 1989;30:261–262.Google Scholar
31.Shaffer, D, Madras, PN, Williams, ME, D’Elia, JAKaldany, AMonaco, AP. Use of Dacron cuffed silicone catheters as long-term hemodialysis access. ASAIO J 1992;38:55–58.Google Scholar
32.Shusterman, NH, Kloss, K, Mullen, JL. Successful use of double-lumen, silicone rubber catheters for permanent hemodialysis access. Kidney Int 1989;35:887–890.Google Scholar
33.Bour, ES, Weaver, AS, Yang, HC, Gifford, RR. Experience with the double lumen silastic catheter for hemoaccess. Gynecol Obstet 1990;171:33–39.Google ScholarPubMed
34.Almirall, J, Gonzalez, J, Rello, J. Infection in hemodialysis catheters: incidence and mechanisms. Am J Nephrol 1989;9:454–459.Google Scholar
35.Sherertz, RJ, Falk, RJ, Huffman, KA, Thomann, CA, Mattern, WD. Infections associated with subclavian Uldall catheters. Arch Intern Med 1983;143:52–56.Google Scholar
36.Blake, PG, Huraib, S, Uldall, PR. The use of the dual lumen jugular venous catheters as definitive long term access for haemodiatysis. Int J Artif Organs 1990;13:26–31.Google Scholar
37.Robinson, DL, Fowler, VG, Sexton, DJ, Corey, RG, Conlon, PJ. Bacterial endocarditis in hemodialysis patients. Am J Kidney Dis 1997;30:521–524.Google Scholar
38.Schwab, SJ, Buller, GL, McCann, RL, Bollinger, RR, Stickel, DL. Prospective evaluation of a Dacron-cuffed hemodialysis catheter for prolonged use. Am J Kidney Dis 1988;11:166–169.Google Scholar
39.Cappello, M, De Pauw, L, Bastin, G, Prospert, F, Delcour, C, Thaysse, C, et al. Central venous access for hemodialysis using the Hickman catheter. Nephrol Dial Transplant 1989;4:988–992.Google Scholar
40.Vanherweghem, JL, Cabolet, P, Dhaene, M. Complications related to subclavian catheters for hemodialysis. Int J Artif Organs 1986;5:297–309.Google Scholar
41.Banerjee, SN, Emori, TG, Culver, DH. Secular trends in nosocomial primary bloodstream infections in the United States, 1980-1989. National nosocomial infections surveillance system. Am J Med 1991;91(suppl 3B):86S–89S.CrossRefGoogle ScholarPubMed
42.Schaberg, DR, Culver, DH, Gaynes, RP. Major trends in the microbial etiology of nosocomial infection. Am J Med 1991;91(suppl 3B):72S–75S.Google Scholar
43.Kirmani, N, Tuazon, CU, Murray, HW, Parrish, AE, Sheagren, JN. Staphylococcus aureus carriage rate of patients receiving long-term hemodialysis. Arch Intern Med 1978;138:1657–1659.CrossRefGoogle ScholarPubMed
44.Goldblum, SE, Reed, WP, Ulrich, JA, Goldman, RS. Staphylococcal carriage and infections in hemodialysis patients. Dialysis and Transplant 1978;7:1140–1148.Google Scholar
45.Yu, VL, Goetz, A, Wagener, M, Smith, PB, Rihs, JD, Hanchett, J, et al. Staphylococcus aureus nasal carriage and infections in patients on hemodialysis. Efficacy of antibiotic prophylaxis. N Engl J Med 1986;315:91–96.Google Scholar
46.Ena, J, Boelaert, JR, Boyken, BA, Van Landuyt, HW, Godard, CA, Herwaldt, LA. Epidemiology of Staphylococcus aureus infections in patients on hemodialysis. Infect Control Hosp Epidemiol 1994;15:78–81.Google Scholar