Hemodialysis infection control

1. 1
Outcome of 16 years of Hemodialysis infection control. Was it successful?
Jafar Alsaid. Teehjaye Sevilla
Introduction:
Hemodialysis related Blood stream infection is the second cause of mortality among ESRD
patients. CDC and NKF had proposed infection control protocols to reduce this rate. We follow
tight infection control protocol since Jan. 2004 in our HD unit. The outcome is presented in this
research.
Aim:
Analysis of the outcome of tight infection control protocol on Hemodialysis blood stream
infection, Bacteremia and admissions over 16 years.
Methodology:
Prospective cohort single unit experience. All the hemodialysis sessions performed from Jan 2004
until Oct. 2019 in our unit were included. The infection control protocol we follow is published
earlier in 2009. (1,2) The type of vascular access was determined for all patients during each
session. The Hemodialysis Bacteremia, Hemodialysis related blood stream infection per 100
patient months and admission for Hemodialysis related blood stream infection per 1000 patient
years were calculated. The International publication was searched to determine the international
corresponding values (3,4). A successful Infection control was considered if the percent we
achieved were comparable or lower than the international reported numbers.
Results:
Total patients are 337.
Total HD sessions 19757.
Duration of the study 189 months.
Total days on Hemodialysis were 53606
Mean Age 59 years
Gender 55% were females.
Vascular access types are presented in graphs (1,2,3).
• Total Patients with Hemodialysis blood stream infection 12
• Total hemodialysis session with blood stream infection 14
• Total patients with Bacteremia were 22
• Total hemodialysis sessions with Bacteremia were 51
Graphs (4,5)
• HD related blood stream infection/100 patient month 0.003
• International reported HD blood stream infection/100 patient month 0.75-4.4 (3,4)
• The admission rate for hemodialysis blood stream infection / 1000 patient days. 0.4

2. 2
• The international admission rate for hemodialysis blood stream infection/1000 patient
year 108
Conclusion:
The infection control protocol followed over 16 years was successful in limiting the hemodialysis
blood stream infection and admissions linked to it far below international rates.
References:
(1) Al-Said J., Pagaduan AC. Infection-free hemodialysis: Can it be achieved? SJKDT.
Saudi Journal of Kidney Diseases and Transplantation 20 (4), 677.
(2) Al-Said J., Pagaduan AC., Merdeshwar S. Successful elimination of hemodialysis-
related bacteremia and vascular access infection. SJKDT 2013.Volume: 24, Issue:6:
1228—1232.
(3) Eduardo K. Lacson, Alan S. Klige Jr. Infection Control and Prevention in Outpatient
Hemodialysis Facilities. Nephrology NephSAP Self-Assessment Program. Volume 18
Number 3 July 2019.
(4) Robert S. Brown ,1 Kristin Brickel,2 and Roger B. Davis3 Two-Year Observational
Study of Bloodstream Infection Rates in Hemodialysis Facility Patients with and
without Catheters. Clin J Am Soc Nephrol 13: 1381–1388, 2018. doi:
https://doi.org/10.2215/CJN.13551217.

3. 3
Table (1) Types of vascular access per patients.
Table (2) Types of vascular access per HD session.

4. 4
Table (3). Progression of vascular access over time within the unit
Table (4) Hemodialysis related blood stream infection per 100 patient months, according to the
access type.

5. 5
Table (5), types of vascular access in patients with Hemodialysis blood stream infection.