1. Intermountain ESRD – Network 15 Karen Strott, RN Linda Pleiman, RN !

2.  Identify 5 evidence based resources proven to reduce HAI’s in the dialysis setting  Review how to implement the use of audits in your QAPI program  Review Wyoming infection data-How does your dialysis unit stack up?

3.  Patients who undergo hemodialysis have a higher risk of infection, due to the following factors:  Frequent use of catheters or insertion of needles to access the bloodstream  Weakened immune systems  Frequent hospital stays and surgery

4.  About 410,000 people receive hemodialysis (HD) at any given time in the United States  About 8 in 10 of these patients start treatment through a central line (a major risk factor for BSI)  Infections are one of the leading causes of hospitalization and death for patients on hemodialysis

5.  For hemodialysis patients, the rate of infection is now 43% greater than it was in 1993!  Hospitalization rates for BSIs have increased by 47% and by 87% for vascular access infections!

6. OutcomePredictor% Increase in Risk** P-value ICD-9 HD VAR Infection Rates -Overall hand hygiene* -Hand Hygiene After -Supplies 1c2 -Insert Needle 1c8 -Injection port 2a9 80% 79% 60% 46% 49% 0.016 0.005 0.042 0.007 NHSN Bacteremia -Dressing 1b7 -Injection port 2a9 50% 54% 0.024 0.007 NHSN VAI -Hand hygiene --Injection port 2a9 51% 43% 0.001 0.023

7. CLABSI prevention in dialysis facilities will require:  Increased adherence to current inpatient CLABSI prevention recommendations  The development and implementation of additional prevention strategies specific to the dialysis environment  Collection and analysis of data

8. CDC Guidance http://www.cdc.gov/ dialysis/collaborative/ Tools website:  http://www.cdc.gov/di alysis/prevention- tools/index.html

9.  Surveillance and feedback using NHSN  Hand hygiene observations  Catheter/vascular access observations  Staff education and competency  Patient education/engagement  Catheter reduction  Chlorhexidine for skin asepsis  Catheter hub disinfection  Antimicrobial ointment

14.  Use chlorhexidine for skin antisepsis during insertion/dressing change (allow to dry)  Catheter hub cleansing (scrub-the-hub) after cap removed and before accessing  Use antimicrobial ointment or chlorhexidine-impregnated sponge dressings

21.  Perform hand hygiene frequently/change gloves  Maintain separate clean areas for supplies and medications and separate contaminated areas for used items  Practice safe injection practices  Perform proper environmental cleaning  Dedicate supplies to a single patient Use aseptic technique every time!

22.  Perform audits on a regular basis  Involve all staff in audit process  Share results with staff  Review audit findings monthly in QAPI  Use results to identify areas for improvement  Perform follow up audits of problem staff or areas identified for improvement  Review and celebrate improvements

23.  Know your data  Share your data  Compare your data to other facilities  Use your data to improve outcomes  Use NHSN to improve communication between patients, staff and other facilities

25. Karen Strott, RN Quality Improvement Director 303.831.8818 kstrott@nw15.esrd.net Linda Pleiman, RN Quality Improvement Coordinator 303.831.8818 lpleiman@nw15.esrd.net Lori Chase QI Data Specialist 303.831.8818 lchase@nw15.esrd.net