Table 5.

Core Interventions for Dialysis BSI Prevention.

Surveillance and feedback	● Conduct monthly surveillance for BSIs and other dialysis events using CDC’s NHSN. ● Calculate facility rates and compare with rates in other NHSN facilities. ● Actively share results with front-line clinical staff.
Hand hygiene observations	● Perform observations of hand hygiene opportunities monthly ● Share results with clinical staff.
Catheter/vascular access care observations	● Perform observations of vascular access care and catheter accessing quarterly. ● Assess staff adherence to aseptic technique when connecting and disconnecting catheters and during dressing changes. ● Share results with clinical staff.
Staff education and competency	● Train staff on infection control topics, including access care and aseptic technique. ● Perform competency evaluation for skills such as catheter care and accessing every 6 to 12 mo and upon hire.
Patient education/engagement	● Provide standardized education to all patients on infection prevention topics including vascular access care, hand hygiene, risks related to catheter use, recognizing signs of infection, and instructions for access management when away from the dialysis unit.
Catheter reduction	● Incorporate efforts (eg, through patient education, vascular access coordinator) to reduce catheters by identifying and addressing barriers to permanent vascular access placement and catheter removal.
Chlorhexidine for skin antisepsis	● Use an alcohol-based chlorhexidine (>0.5%) solution as the first-line skin antiseptic agent for central line insertion and during dressing changes.
Catheter hub disinfection	● Scrub catheter hubs with an appropriate antiseptic after cap is removed and before accessing. Perform every time catheter is accessed or disconnected.
Antimicrobial ointment	● Apply antibiotic ointment or povidone-iodine ointment to catheter exit sites during dressing change.

Source. Adapted from CDC Approach to BSI Prevention in Dialysis Facilities.²²

Note. BSI = bloodstream infection; CDC = Centers for Disease Control and Prevention; NHSN = National Healthcare Safety Network.