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Surveillance of Hemodialysis-Associated Primary Bloodstream Infections: The Experience of Ten Hospital-Based Centers

Published online by Cambridge University Press:  02 January 2015

Margaret Dopirak ,
Connie Hill ,
Marylee Oleksiw ,
Diane Dumigan ,
Jean Arvai ,
Ellen English ,
Evelyn Carusillo ,
Susan Malo-Schlegel ,
Jeana Richo  and
Karen Traficanti
...Show all authors
Margaret Dopirak
Affiliation:
Hartford Hospital, Hartford, Connecticut
Connie Hill
Affiliation:
ESRD Network of New England, New Haven, Connecticut
Marylee Oleksiw*
Affiliation:
Middlesex Hospital, Middletown, Connecticut
Diane Dumigan
Affiliation:
Hospital of St. Raphael, New Haven, Connecticut
Jean Arvai
Affiliation:
New Britain General Hospital, New Britain, Connecticut
Ellen English
Affiliation:
Rockville General Hospital, Rockville, Connecticut
Evelyn Carusillo
Affiliation:
Charlotte Hungerford Hospital, Torrington, Connecticut
Susan Malo-Schlegel
Affiliation:
Hartford Hospital, Hartford, Connecticut
Jeana Richo
Affiliation:
VA Connecticut Healthcare System, West Haven, Connecticut
Karen Traficanti
Affiliation:
Rockville General Hospital, Rockville, Connecticut
Bobbie Welch
Affiliation:
Danbury Hospital, Danbury, Connecticut
Brian Cooper
Affiliation:
University of Connecticut, Farmington, Connecticut
*
Middlesex Hospital, 28 Crescent Street, Middletown, CT 06457
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Abstract

Objective:

To determine baseline rates of primary bloodstream infection (BSI) among a large pool of patients receiving hemodialysis using standardized surveillance tools and methodology.

Design:

Prospective, descriptive analysis of primary BSI rates.

Setting:

Ten hospital-based hemodialysis centers in Connecticut.

Patients:

All patients receiving long-term hemodialysis in the participating facilities.

Results:

A total of 158 BSIs occurred during 142,525 dialysis sessions within a 12-month study period. Of the BSIs, 15.2% occurred in patients with fistula or graft access and 84.8% in patients with central venous catheter access (P < .001). Rates per 100 patient-years in centers ranged from 0 to 30.8, with a mean of 16.6. Rates per 1,000 dialysis sessions ranged from 0 to 2.1, with a mean of 1.1. Coagulase-negative staphylococci and Staphylococcus aureus (including methicillin-resistant S. aureus) accounted for 61% and Klebsiella or Enterobacter species for 14.6% of infections. Of the patients, 63.3% received vancomycin, 24.7% received cefazolin, and 41.7% received aminoglycosides. Rates declined in the second 6 months of the study from 1.4 to 0.8 infections per 1,000 dialysis sessions (P < .001).

Conclusions:

Primary BSI rates varied widely among participating centers and declined during the study period. BSIs were strongly associated with central venous catheter access. Further studies are needed to determine the reasons for variance in rates between centers and among various types of hemodialysis access.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 23 , Issue 12 , December 2002 , pp. 721 - 724
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2002

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