Standardized Surveillance of Hemodialysis Vascular Access Infections 18-Month Experience at an Outpatient, Multifacility Hemodialysis Center

2000 ◽  
Vol 21 (3) ◽  
pp. 200-203 ◽  
Author(s):  
Kurt B. Stevenson ◽  
Michael J. Adcox ◽  
Michael C. Mallea ◽  
Nagraj Narasimhan ◽  
Jon P. Wagnild
Keyword(s):  
Vascular Access ◽  
Descriptive Analysis ◽  
Bloodstream Infections ◽  
Central Catheter ◽  
Infection Rates ◽  
Clinical Sepsis ◽  
Incidence Data ◽  
Hemodialysis Vascular Access ◽  
Catheter Infections ◽  
Synthetic Grafts

AbstractObjective:To develop a standardized surveillance system for monitoring hemodialysis vascular-access infections in order to compare infection rates between outpatient sites and to assess the effectiveness of infection control interventions.Design:Prospective descriptive analysis of incidence infection rates.Setting:An outpatient hemodialysis center with facilities in Idaho and Oregon.Patients:All outpatients receiving chronic outpatient hemodialysis.Results:There were 38,096 hemodialysis sessions (31,603 via permanent fistulae or grafts, 5,060 via permanent tunneled central catheters, and 1,433 via temporary catheters) during an 18-month study period in 1997 to 1998. We identified 176 total infections, for a rate of 4.62/1,000 dialysis sessions (ds). Of the 176, 80 involved permanent fistulae or grafts (2.53/1,000 ds), 69 involved permanent tunneled central catheter infections (13.64/1,000 ds), and 27 involved temporary catheter infections (18.84/1,000 ds). There were 35 bloodstream infections (0.92/1,000 ds) and 10 episodes of clinical sepsis (0.26 /1,000 ds). One hundred thirty-one vascular-site infections without bacteremia were identified (3.44/1,000 ds), including 65 permanent fistulae or graft infections (2.06/1,000 ds), 42 permanent tunneled central catheter infections (8.3/1,000 ds), and 24 temporary catheter infections (16.75/1,000 ds).Conclusions:Infection rates were highest among temporary catheters and lowest among permanent native arteriovenous fistulae or synthetic grafts. This represents the first report of extensive incidence data on hemodialysis vascular access infections and represents a standardized surveillance and data-collection system that could be implemented in hemodialysis facilities to allow for reliable data comparison and benchmarking.

Impact of a Peripheral Vascular Access Service on Device Use

2021 ◽  
Vol 30 (4) ◽  
pp. 295-301
Author(s):  
Celia Wells ◽  
Ziya Zhang ◽  
Christy Chan ◽  
Amy Brito ◽  
Roopa Kohli-Seth
Keyword(s):  
Vascular Access ◽  
Descriptive Analysis ◽  
Bloodstream Infections ◽  
Central Catheter ◽  
Peripheral Vascular ◽  
Peripheral Vasculature ◽  
Vascular Access Devices ◽  
Access Service ◽  
The Impact ◽  
Central Catheters

Background More than 1 billion peripheral vascular access devices are inserted annually worldwide with potential complications including infection, thrombosis, and vasculature damage. Vasculature damage can necessitate the use of central catheters, which carry additional risks such as central catheter–associated bloodstream infections. To address these concerns, one institution used expert nurses and a consult request system with algorithms embedded in the electronic medical record. Objectives To develop a uniform process for catheter insertion by means of a peripheral vascular access service dedicated to selecting, placing, and maintaining all inpatient peripheral catheters outside of the intensive care units. Methods Descriptive analysis and χ2 analysis were done to describe the impact of the peripheral vascular access service. Results In 2018, 6246 consults were reviewed. Of these, 26% did not require vascular access. Similarly, in 2019, 7861 consults were reviewed, and 35.3% did not require vascular access. Use of central catheters decreased from 21% in 2017 to 17% in 2018 and 2019. Conclusions The peripheral vascular access service allowed patients to receive appropriate peripheral vascular access devices and avoid unnecessary peripheral catheter placements. This may have preserved patients’ peripheral vasculature and thus prevented premature central catheter placement and contributed to an overall decrease in central catheter days. With the peripheral vascular access service, peripheral vascular access devices were selected, placed, and maintained by experts with a standardized process that promoted a culture of quality and patient safety.

The case for using a disinfecting cap for needlefree connectors

2019 ◽  
Vol 28 (14) ◽  
pp. S22-S27
Author(s):  
Andrew Barton
Keyword(s):  
Vascular Access ◽  
Bloodstream Infections ◽  
Infection Rates ◽  
Central Venous ◽  
High Demand ◽  
Vascular Access Devices ◽  
Care Bundles ◽  
Published Evidence ◽  
Different Types ◽  
The Cost

Catheter-related bloodstream infections (CRBSIs) are a signification cause of infection. When CRBSI rates are high, the cost to the patient and the organisation can be significant. More than ever before, there is a high demand for vascular access. Advances in treatment often entail extended indwell times for central vascular access devices. The care and maintenance of these devices is crucial in avoiding complications such as infection. Using care bundles in conjunction with other simple interventions, such as passive disinfecting caps, can help reduce CRBSI rates. The published evidence demonstrates that passive disinfecting caps can help reduce infection rates associated with different types of central venous catheters by protecting needlefree connectors from colonisation by pathogens and serving as a clear indicator that the line has been disinfected.

Educational Interventions to Reduce the Rate of Central Catheter–Related Bloodstream Infections in the NICU: A Review of the Research Literature

2009 ◽  
Vol 28 (6) ◽  
pp. 391-395 ◽  
Author(s):  
Carrie Semelsberger
Keyword(s):  
Reduction Rate ◽  
Bloodstream Infections ◽  
Cost Effective ◽  
Educational Interventions ◽  
Research Literature ◽  
Central Catheter ◽  
Infection Rates ◽  
Central Venous ◽  
Neonatal Nurses ◽  
Before And After

Catheter–related bloodstream infections (CR-BSIs) are a significant cause of morbidity and mortality in the NICU, occurring at rates ranging from 11.3 per 1,000 catheter days in infants <1,000 g to 4 per 1,000 catheter days in infants >2,500 g. Cost-effective and successful educational interventions aimed at nurses have been shown to decrease CR-BSIs with adults, but no such studies address neonatal nurses. This literature review examined how educational interventions could help neonatal nurses reduce infection rates in patients with central venous catheters. Four databases were searched: PubMed, CINAHL, Cochrane, and OVID. Of ten studies that measured CR-BSIs before and after educational interventions, nine showed a postintervention reduction in the rate of CR-BSIs of 40 percent or greater (eight demonstrating statistically significant reductions), and the tenth reported a reduction rate of 21 percent. All of the educational programs had additional intervention components, so it is not possible to ascribe all the success to the education, but this review suggests that this topic needs to be studied with the NICU population.

Prospective Surveillance for Primary Bloodstream Infections Occurring in Canadian Hemodialysis Units

2002 ◽  
Vol 23 (12) ◽  
pp. 716-720 ◽  
Author(s):  
Geoffrey Taylor ◽  
Denise Gravel ◽  
Lynn Johnston ◽  
John Embil ◽  
Donna Holton ◽  
...  
Keyword(s):  
Bloodstream Infection ◽  
Vascular Access ◽  
Significant Variation ◽  
Bloodstream Infections ◽  
Venous Catheter ◽  
Surveillance Program ◽  
Infection Rates ◽  
Prospective Surveillance ◽  
Infection Surveillance

Objective:Bloodstream infections are a major cause of morbidity and mortality in patients receiving long-term hemodialysis. We wanted to determine the incidence of hemodialysis-related bloodstream infections in Canadian centers participating in the Canadian Nosocomial Infection Surveillance Program.Methods:Prospective surveillance for hemodialysis-related bloodstream infections was performed in 11 centers during a 6-month period. Bloodstream infections were defined by published criteria. Hemodialysis denominators included the number of dialysis procedures, the number of patient-days on dialysis, and the frequencies of different types of vascular access.Results:There were 184 bloodstream infections in 133,158 dialysis procedures (1.4 per 1,000) and 316,953 patient-days (0.6 per 1,000). Hemodialysis access through arteriovenous (AV) fistulae was associated with the lowest risk for bloodstream infection (0.2 per 1,000 dialysis procedures). The relative risk for infection was 2.5 with AV graft access, 15.5 with cuffed and tunneled central venous catheter (CVC) access, and 22.5 with uncuffed CVC access (P < .001). There was marked variation among the 11 centers in the means of vascular access used for hemodialysis. Significant variation in infection rates was observed among the centers when controlling for types of access.Conclusions:There was a hierarchy of risk of hemodialysis-related bloodstream infection according to type of vascular access. There was significant variation in the type of vascular access being used among the Canadian hemodialysis centers, and also variation in access-specific infection rates between centers.

P1350A COMPARISON OF CENTRAL VENOUS CATHETER INFECTIONS FOR HEMODIALYSIS AND HEMATOLOGY PATIENTS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Ahmet Murt ◽  
Mevlut Tamer Dincer ◽  
Abdulkadir Ercaliskan ◽  
Cebrail Karaca ◽  
Tugrul Elverdi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Bloodstream Infections ◽  
Hemodialysis Patients ◽  
Infection Risk ◽  
Infection Rates ◽  
Exit Site ◽  
Central Venous ◽  
Gram Positive ◽  
Delayed Complications ◽  
Catheter Infections

Abstract Background and Aims In addition to nephrologists who use central venous catheters (CVCs) as venous access for hemodialysis, it is also a routine practice for hematologists to benefit from them for their medical applications. There may be immediate or delayed complications of CVC placement and infections are accepted as delayed complications. We aimed to compare CVC-related infections in hematology and hemodialysis patients groups both of whose CVCs were placed by interventional nephrologists. Group specific infectious agents as well as infection risk factors were analyzed in order to develop guides and practices to decrease infection rates for the future. Method The number of patients who were placed a CVC in bone marrow transplantation (BMT) unit was 69 (37 males, 32 females) in the year of 2019. These patients were 47,5 ± 14,3 years old. Their CVC infection numbers and rates as well as infection agents were analyzed. This group was compared with hemodialysis patients that have non-cuffed hemodialysis catheters and who were age and sex matched with the BMT group. Infection rates for 1000 catheter days were calculated separately for both groups. Catheter infections were defined as hemoculture positivity of samples obtained from catheter lumens and/or identification of any microorganism in the catheter tip. Cases were followed up from insertion day of the catheters until when infection was identified or until the day of catheter removal. Results Catheters remained in a central vein for a median of 25 days in hemodialysis group [range: 10-51 days] while these duration was 16 days [range:8-29 days] for BMT group. The number of cases in whom a catheter related infection was identified was 17 for BMT (24%) and nine (13%) for hemodialysis group. Infection rate was 23 for 1000 catheter days in BMT group while it was 11 for 1000 catheter days in hemodialysis patients. BMT patients have a wider range of infection agents; 78% of them being gram positives and 19% of them being gram negatives. It was noteworthy that all of the catheter related infections in hemdialysis patients were related to gram positive bacteria. Rate of infections due to extended spectrum beta lactamase (ESBL) secreting E.coli or Klebsiella was 24% and infection risk of ESBL secreting agents was directly proportional to the time spent with the catheter. Infection findings in the catheter exit site (e.g. erythema, crusts or effusions) was found as statistically significant risk factors for bloodstream infections in BMT patients while these factors were not statistically significant for hemodialysis patients. Conclusion Gram positive infections make up the majority of CVC-related infections both for hematology and hemodialysis patients. Infection risks due to resistant species is proportional to the time spent with catheters. Catheter exit site findings should be cautionary for probable bloodstream infections especially for immunosuppressed patients.

Diagnostic ultrasound imaging of hemodialysis vascular access-related complications

Choonpa Igaku ◽  
2019 ◽  
Vol 46 (2) ◽  
pp. 171-180
Author(s):  
Hiroki KOBAYASHI ◽  
Kotaro SUEMITSU ◽  
Masayoshi NANAMI
Keyword(s):  
Ultrasound Imaging ◽  
Vascular Access ◽  
Diagnostic Ultrasound ◽  
Hemodialysis Vascular Access

scholarly journals Interventional nephrology and vascular access practice: A perspective from South and Southeast Asia

2021 ◽  
pp. 112972982110113
Author(s):  
Raja Ramachandran ◽  
Vinant Bhargava ◽  
Sanjiv Jasuja ◽  
Maurizio Gallieni ◽  
Vivekanand Jha ◽  
...  
Keyword(s):  
Southeast Asia ◽  
Vascular Access ◽  
Central Catheter ◽  
Middle Income ◽  
Middle Income Countries ◽  
South And Southeast Asia ◽  
Group 2 ◽  
Venous Fistula ◽  
Economic Constraints ◽  
Group 1

South and Southeast Asia is the most populated, heterogeneous part of the world. The Association of Vascular Access and InTerventionAl Renal physicians (AVATAR Foundation), India, gathered trends on epidemiology and Interventional Nephrology (IN) for this region. The countries were divided as upper-middle- and higher-income countries as Group-1 and lower and lower-middle-income countries as Group-2. Forty-three percent and 70% patients in the Group 1 and 2 countries had unplanned hemodialysis (HD) initiation. Among the incident HD patients, the dominant Vascular Access (VA) was non-tunneled central catheter (non-TCC) in 70% of Group 2 and tunneled central catheter (TCC) in 32.5% in Group 1 countries. Arterio-Venous Fistula (AVF) in the incident HD patients was observed in 24.5% and 35% of patients in Group-2 and Group-1, respectively. Eight percent and 68.7% of the prevalent HD patients in Group-2 and Group-1 received HD through an AVF respectively. Nephrologists performing any IN procedure were 90% and 60% in Group-2 and Group 1, respectively. The common procedures performed by nephrologists include renal biopsy (93.3%), peritoneal dialysis (PD) catheter insertion (80%), TCC (66.7%) and non-TCC (100%). Constraints for IN include lack of time (73.3%), lack of back-up (40%), lack of training (73.3%), economic issues (33.3%), medico-legal problems (46.6%), no incentive (20%), other interests (46.6%) and institution not supportive (26%). Routine VA surveillance is performed in 12.5% and 83.3% of Group-2 and Group-1, respectively. To conclude, non-TCC and TCC are the most common vascular access in incident HD patients in Group-2 and Group-1, respectively. Lack of training, back-up support and economic constraints were main constraints for IN growth in Group-2 countries.

scholarly journals Epidemiology of Clavicle Fractures Sustained at a Colorado Ski Resort

2021 ◽  
Vol 9 (5) ◽  
pp. 232596712110067
Author(s):  
Lauren Oberle ◽  
Lauren Pierpoint ◽  
Jack Spittler ◽  
Morteza Khodaee
Keyword(s):  
Medical Center ◽  
Descriptive Analysis ◽  
Clavicle Fracture ◽  
Sports Injury ◽  
Common Mechanism ◽  
Ski Resort ◽  
Incidence Data ◽  
Injury Mechanisms ◽  
Fracture Diagnosis ◽  
Clavicle Fractures

Background: Although clavicle fractures are a common sports injury, there are limited studies on the incidence and causes of clavicle fractures among winter sports athletes. Purpose: To evaluate the characteristics and injury mechanisms associated with clavicle fractures among patients evaluated at a Colorado ski resort. Study Design: Descriptive epidemiology study. Methods: This was a retrospective descriptive analysis of patients with clavicle fractures at the Denver Health Winter Park Medical Center during the 2012-2013 to 2016-2017 ski seasons. Chart review was performed on the patient cohort to confirm clavicle fracture diagnosis and to evaluate factors associated with clavicle fracture. Results: A total of 393 clavicle fractures (6.2% of total clinic visits) occurred during the study period, corresponding to an overall clavicle fracture incidence of 8.4 per 100,000 participant-visits. The mean patient age was 26.4 years (range, 5-73 years). The majority were middle-third fractures (85.5%), occurring mainly in men (87.3%). More than half of the fractures were comminuted (54.5%) and occurred in snowboarders (55.0%). The most common mechanism of injury was a fall onto snow while skiing or snowboarding (92.4%). Women sustained more clavicle fractures while skiing compared with snowboarding (82.0% vs 18.0%; P < .001), while men sustained more fractures while snowboarding compared with skiing (60.3% vs 39.7%; P < .001). Conclusion: Clavicle fractures are relatively common, but there are scant incidence data for clavicle fractures in mountain sports. Consistent with prior studies, clavicle fractures were more common in younger patients and men. The most common anatomic fracture location was the midclavicle. A greater proportion of clavicle fractures among men were sustained during snowboarding and among women during skiing.

Differences in Initial Hemodialysis Vascular Access Use Among Glomerulonephritis Subtypes in the United States

2016 ◽  
Vol 67 (4) ◽  
pp. 638-647 ◽  
Author(s):  
Michelle M. O’Shaughnessy ◽  
Maria E. Montez-Rath ◽  
Yuanchao Zheng ◽  
Richard A. Lafayette ◽  
Wolfgang C. Winkelmayer
Keyword(s):  
United States ◽  
Vascular Access ◽  
The United States ◽  
Hemodialysis Vascular Access
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