Outpatient dialysis centers can significantly reduce the incidence of vascular access-related bloodstream infections (BSIs) using collaborative interventions, and introducing social and behavioral change processes according to the CDC.
A 2010 a CDC Vital Signs report brought attention to the high number of BSIs occurring in outpatient hemodialysis patient settings, a situation associated with substantial morbidity that, unlike BSIs in inpatient settings, showed no sign of decreasing.
The reports, which appears in March 16 Morbidity and Mortality Weekly Report (MMWR)  examines the efforts of the dialysis unit at AtlantiCare Regional Medical Center, a 12-station, hospital-based outpatient hemodialysis center serving patients in Atlantic City region.
The Center adopted uniform package of BSI prevention intervention  such as:
- Observation of catheter care and vascular access care
- Use of chlorhexidine for skin antisepsis
- Auditing of hand hygiene adherence
- Patient education and engagement
- Catheter use reduction programs
- Staff member education and competency testing
Positive deviance approach to social and behavioral efforts encouraged “staff members to take personal responsibility for BSI prevention,” according to the report. “For example, one nurse used a mnemonic device to achieve near-perfect hand hygiene compliance, which she taught to the other nurses.”
The center saw a access-related BSIs decrease from 2.04 per 100 patient-months to 0.24 per 100 patient-months, according to the report.
“Health-care–associated infections, including BSIs, are an ongoing hazard for patients who receive their care primarily as outpatients. Based on the success at this facility and the success of similar programs in other health-care settings, the approach described in this report might be effective in other outpatient dialysis facilities to prevent BSIs,” the report concludes.