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Outbreak of Hemodialysis Vascular Access Site Infections Related to Malfunctioning Permanent Tunneled Catheters: Making the Case for Active Infection Surveillance

Published online by Cambridge University Press:  02 January 2015

Elizabeth L. Hannah ,
Kurt B. Stevenson ,
Connie A. Lowder ,
Michael J. Adcox ,
Robert L. Davidson ,
Michael C. Mallea ,
Nagraj Narasimhan  and
Jon P. Wagnild
Elizabeth L. Hannah*
Affiliation:
PRO-West, Saint Alphonsus Nephrology Center and Idaho Nephrology Associates, LLC, Boise, Idaho
Kurt B. Stevenson
Affiliation:
PRO-West, Saint Alphonsus Nephrology Center and Idaho Nephrology Associates, LLC, Boise, Idaho
Connie A. Lowder
Affiliation:
PRO-West, Saint Alphonsus Nephrology Center and Idaho Nephrology Associates, LLC, Boise, Idaho
Michael J. Adcox
Affiliation:
Saint Alphonsus Nephrology Center and Idaho Nephrology Associates, LLC, Boise, Idaho
Robert L. Davidson
Affiliation:
Saint Alphonsus Nephrology Center and Idaho Nephrology Associates, LLC, Boise, Idaho
Michael C. Mallea
Affiliation:
Saint Alphonsus Nephrology Center and Idaho Nephrology Associates, LLC, Boise, Idaho
Nagraj Narasimhan
Affiliation:
Saint Alphonsus Nephrology Center and Idaho Nephrology Associates, LLC, Boise, Idaho
Jon P. Wagnild
Affiliation:
Saint Alphonsus Nephrology Center and Idaho Nephrology Associates, LLC, Boise, Idaho
*
PRO-West, 720 Park Boulevard, Suite 120, Boise, ID 83712-7756
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Abstract

Objective:

To describe an outbreak of infections with permanent cuffed hemodialysis catheters recognized through ongoing surveillance and related to a specific malfunctioning permanent catheter.

Design:

The outbreak was suspected from the results of prospective infection surveillance and confirmed by a retrospective cohort study using medical records for patients receiving dialysis between April 1,1999, and March 31, 2000.

Setting:

Integrated network of six outpatient hemodialysis facilities in southern Idaho and eastern Oregon.

Patients:

Outpatients receiving long-term hemodialysis.

Results:

During the 18 months prior to the outbreak, the overall infection rate was 4.1 infections per 1,000 dialysis sessions with a catheter rate of 8.9 per 1,000 dialysis sessions. During the 7 months of the outbreak, the overall rate increased to 5.8 per 1,000 dialysis sessions, whereas the catheter rate increased to 18.1 per 1,000 dialysis sessions. Reports of malfunctioning “Brand A” catheters prompted discontinuation of their placement. A manufacturer recall occurred in April 2000. During the 14 months after the outbreak, the overall infection rate decreased to 3.3 per 1,000 dialysis sessions and the catheter rate to 10.8 per 1,000 dialysis sessions. A 12-month retrospective cohort study recognized 96 patients with an identifiable catheter brand and 48 infections. Of these, 27 (56%) occurred in patients with Brand A catheters. The relative risk for infection when compared with other catheter brands was 1.96 (95% confidence interval, 1.32 to 2.92; P < .001).

Conclusions:

Ongoing infection surveillance in hemodialysis facilities can identify specific device-related outbreaks of infections and promote interventions to reduce infectious complications and promote patient safety. Surveillance for vascular access site infections is recommended as a routine activity in hemodialysis facilities.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 23 , Issue 9 , September 2002 , pp. 538 - 541
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2002

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