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Variation in Infection Prevention Practices in Dialysis Facilities: Results From the National Opportunity to Improve Infection Control in ESRD (End-Stage Renal Disease) Project

Published online by Cambridge University Press:  16 March 2015

Carol E. Chenoweth ,
Stephen C. Hines ,
Kendall K. Hall ,
Rajiv Saran ,
John D. Kalbfleisch ,
Teri Spencer ,
Kelly M. Frank ,
Diane Carlson ,
Jan Deane  and
Erik Roys
...Show all authors
Carol E. Chenoweth*
Affiliation:
University of Michigan, Ann Arbor, Michigan
Stephen C. Hines
Affiliation:
Health Research and Educational Trust, Chicago, Illinois
Kendall K. Hall
Affiliation:
Agency for Healthcare Research and Quality, Rockville, Maryland
Rajiv Saran
Affiliation:
University of Michigan, Ann Arbor, Michigan
John D. Kalbfleisch
Affiliation:
University of Michigan, Ann Arbor, Michigan
Teri Spencer
Affiliation:
TB Spencer Consulting, Fallbrook, California
Kelly M. Frank
Affiliation:
Centers for Medicaid and Medicare Services, Waterloo, Iowa
Diane Carlson
Affiliation:
Renal Network of the Upper Midwest, St. Paul, Minnesota
Jan Deane
Affiliation:
Renal Network of the Upper Midwest, St. Paul, Minnesota
Erik Roys
Affiliation:
University of Michigan, Ann Arbor, Michigan
Natalie Scholz
Affiliation:
University of Michigan, Ann Arbor, Michigan
Casey Parrotte
Affiliation:
University of Michigan, Ann Arbor, Michigan
Joseph M. Messana
Affiliation:
University of Michigan, Ann Arbor, Michigan
*
Address correspondence to Carol E. Chenoweth, MD, 3119 Taubman Center, University of Michigan Medical Center, 1500 E. Medical Center Dr, Ann Arbor, MI 48109-5378 (cchenow@umich.edu).
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Abstract

OBJECTIVE

To observe patient care across hemodialysis facilities enrolled in the National Opportunity to Improve Infection Control in ESRD (end-stage renal disease) (NOTICE) project in order to evaluate adherence to evidence-based practices aimed at prevention of infection.

SETTING AND PARTICIPANTS

Thirty-four hemodialysis facilities were randomly selected from among 772 facilities in 4 end-stage renal disease participating networks. Facility selection was stratified on dialysis organization affiliation, size, socioeconomic status, and urban/rural status.

MEASUREMENTS

Trained infection control evaluators used an infection control worksheet to observe 73 distinct infection control practices at the hemodialysis facilities, from October 1, 2011, through January 31, 2012.

RESULTS

There was considerable variation in infection control practices across enrolled facilities. Overall adherence to recommended practices was 68% (range, 45%–92%) across all facilities. Overall adherence to expected hand hygiene practice was 72% (range, 10%–100%). Compliance to hand hygiene before and after procedures was high; however, during procedures hand hygiene compliance averaged 58%. Use of chlorhexidine as the specific agent for exit site care was 19% overall but varied from 0% to 35% by facility type. The 8 checklists varied in the frequency of perfect performance from 0% for meeting every item on the checklist for disinfection practices to 22% on the arteriovenous access practices at initiation.

CONCLUSIONS

Our findings suggest that there are many areas for improvement in hand hygiene and other infection prevention practices in end-stage renal disease. These NOTICE project findings will help inform the development of a larger quality improvement initiative at dialysis facilities.

Infect Control Hosp Epidemiol 2015;36(7):802–806

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 36 , Issue 7 , July 2015 , pp. 802 - 806
Copyright
© 2015 by The Society for Healthcare Epidemiology of America. All rights reserved 

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