Transcript Infection Control in Hemodialysis Setting

Infection Control in
Hemodialysis Setting
Source: Kallen AJ, Arduino MJ, Patel
PR. Preventing infections in patients
undergoing hemodialysis. Expert Rev
Anti Infect Ther. 2010;8(6):643–655.
Overview
• Infections are a prime cause of morbidity and mortality in end-stage
renal disease patients.
• In patients on hemodialysis, infections related to hospitalizations
have elevated by 26% from 1993 to 2007.
• With the increase in cases transmission of bloodborne hepatitis
viruses in outpatient healthcare settings, including hemodialysis
centers, related to suboptimal infection control and injection safety
practices, the patient safety concerns have increased.
• The centers for disease control and prevention’s (CDC) study on the
efficacy of nosocomial infection control (SENIC) recommends that,
hospitals could reduce the occurrence of healthcare-onset
infections by about one-third by adopting an infection control
program.
• Figure 1 depicts some of the infection control measures.
Current Infection Control Issues in
Hemodialysis Setting
Preventing Transmission of Hepatitis B & C
• Hepatitis B virus (HBV) infection could be prevented with
vaccination, and this is recommended for all patients under
chronic hemodialysis.
• Complete hepatitis B serologic status of the patient should be
recorded before initiating dialysis and all vulnerable patients
should be vaccinated.
• Other practices for controlling infection include, avoiding the
exposure of vulnerable patients to infected blood, isolation of
HBV-infected patients, preventing same staff members to
care for HBV-infected and susceptible patients, and ensuring
that specific dialysis equipment and other supplies dedicated
for infected patients are not used for susceptible patients.
Preventing Transmission of Hepatitis B & C
• The occurrence of antibody to hepatitis C virus (HCV) is seen to be higher
in
• hemodialysis patients (7.8%) as compared to the general population
(1.6%), which may elevate depending on the duration of dialysis.
• Hepatitis C virus is mainly transferred through percutaneous contact with
blood; thereby posing the hemodialysis patient at a risk for infection
through transmission.
• Preventive steps for controlling HCV transmission in dialysis settings have
been primarily focused on secure injection practices, employment of hand
hygiene, and ample cleaning of environmental surfaces and equipment
among patients.
• In general, infection preventive steps include the restricted use of supplies
and items taken into the dialysis station for individual patients, or cleaning
and disinfecting them or disposing them in case they cannot be cleaned or
disinfected, use of clean area far from dialysis stations for preparing
medications, avoiding the usage of common medication carts for
medications delivery to patients, cleaning and disinfecting of stations
between patients, and proper use of hand hygiene.
• The CDC also suggest that patients should be tested for the antibody to
HCV during admission and then semi-annually.
Preventing Influenza
• Vaccination is one of the prime steps used to control
influenza infection in hemodialysis patients. In longterm care facilities, it has been observed that
vaccination of staff members is linked with reduced
influenza-like illness and the overall mortality in
residents.
• Educating dialysis staff on HCP vaccination, respiratory
hygiene and cough etiquette, and actions to avoid the
respiratory virus transmission are also important.
• Staff members should not work if they are ill with
contagious illnesses such as influenza.
Preventing Bloodstream Infections
• Bloodstream infections are associated with high levels of
morbidity and mortality.
• The bloodstream infection (BSI) rates in patients
undergoing hemodialysis differs based on the nature of
vascular access that is present.
• Hand hygiene, insertion practices, skin cleaning are widely
recommended for preventing BSI.
• The CDC and kidney disease outcomes quality initiative
(KDOQI) recommends that topical antimicrobial ointments
should be applied to the catheter exit site.
• There also has been growing interest in the use of
antimicrobial catheter locking solutions for preventing BSIs
associated with catheter use.
Environmental Cleaning
• Studies have evidenced that blood borne
pathogens like HBV and HCV could be found
on several surfaces within the dialysis unit.
• The appropriate use of detergents and
disinfectants is an important component of
achieving environmental cleaning.
Injection Safety
• Inappropriate management of shared
medication vialscould lead to contamination.
Some of the unsafe injection practices linked
to blood borne pathogen outbreaks include
preparation of parenteral medications for
multiple patients in patient treatment areas
and reuse of single-dose medications for
multiple patients.
Preventing Transmission of
Multidrug-resistant Organisms
• Studies have shown that the risk for invasive
multidrugresistant organisms (MDRO)
infections is several folds greater for dialysis
patients than for the general population.
• The recommended infection control practices,
if followed properly could emerge out as a
useful way to restrict transmission of MDROs
in hemodialysis patients.
Decolonization
• Colonization with S. aureus is a known risk
factor for subsequent S. aureus infections in
hemodialysis patients.
• Decolonization on overall infections is not very
clear, although it has been observed that
decolonization reduces S. aureus infections in
hemodialysis patients.
Conclusion
• Careful surveillance and proper execution of infection control
recommendations can help control infection in patients under
hemodylasis. Bloodstream infections is critical, but is often ignored.
Employment of CDC surveillance methods and application of
surveillance data have been observed to be associated with the
reduction in the incidence of BSI and other serious events.
• The infection control program can be successfully implemented
• with trained professionals and through evidence-based strategies.
• Further issues revolving infection control in dialysis setting include
the requirement for additional prevention research, a better
emphasis on observation and documenting of adverse dialysis
events, and the implementation of novel shared models.
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