Preventing Bloodstream Infections in Hemodialysis Patients

Bloodstream Infections (BSI) are dangerous complications and leading cause of death in hemodialysis patients.  This webpage provides resources and guidance to California health care personnel and the dialysis community, infection prevention guidelines and recommendations, clinician and patient education, hemodialysis clinic infection prevention tools, and the use of the National Healthcare Safety Network (NHSN) for monitoring progress in reducing BSI in dialysis clinics in California.

Infection Prevention Guidelines and Recommendations

• CDC Approach to BSI Prevention in Dialysis Facilities (PDF)
  Nine core interventions to prevent dialysis-related BSI.
• CDC Infection Control Requirements for Dialysis Facilities and Clarification Regarding Guidance on Parenteral Medication Vials
  CDC recommendations on parenteral medication and clarification on the inclusion of bloodborne viral infection. 
• CDC Guide to Infection Prevention for Outpatient Settings: Minimum Expectations for Safe Care
  I​nfe​​ction Prevention checklist for Outpatient Settings.​
• CDC Infection Prevention Checklist for Outpatient Settings: Minimum Expectations for Safe Care (PDF)
  Infection Prevention checklist for Outpatient Settings.​
• CDC 2011 Guidelines for the Prevention of Intravascular Catheter-Related Infection
  Evidenced-based recommendations for preventing intravascular catheter-related infections.
• Cambridge Core: Infection Control & Hospital Epidemiology |  Strategies to prevent central line-associated bloodstream infections in acute-care hospitals: 2022 Update
  CLABSI prevention practice recommendations from the 2022 Compendium.

Infection Prevention Education

• CDC Provider Training Video: Preventing Bloodstream Infections in Outpatient Hemodialysis Patients: Best Practices for Dialysis Staff (PDF)
  Best practices for dialysis staff for prevention of bloodstream infections in patients receiving hemodialysis.
• CDC Continuing Education Course: Infection Prevention in Dialysis Settings
  Continuing education for infection prevention in dialysis settings for healthcare workers.
• AHRQ Safety Program for End-Stage Renal Disease Facilities – Toolkit
  Four instructional modules that a facilitator can use to teach dialysis center team members specific ways to create a culture of safety and prevent healthcare-associated infections in dialysis patients. Created by Agency for Healthcare Research and Quality (AHRQ) for End-Stage Renal Disease (ESRD) clinics.

Infection Surveillance, Prevention Strategies and Best Practices

• CDC NHSN Tracking Infections in Outpatient Dialysis Facilities
  NHSN training and support material for reporting dialysis events, process measures and data analysis.
• CDC NHSN Dialysis Event Surveillance Protocol
  Dialysis event definitions and event surveillance protocol  
• CDC Best Practices for Bloodstream Infection Prevention in Dialysis Setting | Dialysis Safety
  Core interventions for bloodstream infection prevention in outpatient dialysis centers including resources for staff education and implementation.
• CDC Preventing Bloodstream Infections in People on Dialysis | VitalSigns
  Preventing infections among patients receiving dialysis from all racial, ethnic, and socioeconomic groups.
• CDC Strategies for Improving Antibiotic Use in Outpatient Hemodialysis Facilities | Antibiotic Prescribing and Use
• APIC Infection Prevention and Control in Dialysis Settings (2022) 
  Updated guide for dialysis setting on the fundamentals for understanding kidney disease, standard and transmission-based precautions, and best practices for keeping hemodialysis patients safe from infection.
  

Checklists, Posters, and Tools for Use in Dialysis Clinics

Information for Dialysis Patients

• CDC Speak Up: Making Dialysis Safer for Patients Video (Opens in YouTube)
  This video follows the journey of two patients on dialysis who feel empowered to speak up and share concerns about their treatment in order to prevent infections.
• CDC Comic: Engaging Patients in the Infection Prevention Conversation (PDF)
  Provides helpful tips and reminders about patient and caregiver engagements.
• CDC Patient Pocket Guide: 6 Tips to Prevent Dialysis Infections (PDF)
  Pocket sized guide for hemodialysis patients with tips on how to prevent infections.
• CDC: Infection Control and Bloodstream Infection Prevention: The Perspective of Patients Receiving Hemodialysis (PDF)
  Focus group for patients taking a role in infection prevention.
• CDC Infections and Patients on Dialysis | Dialysis Safety (PDF)
  Steps for dialysis patients to take to prevent infections while receiving hemodialysis
• ESRD Network: Dialysis Patients Speak: a Conversation about the Importance of AV Fistulas (opens in YouTube)
  Educational video on hemodialysis patients speaking about the importance of AV fistulas for vascular access.
• ESRD Network: Dialysis Patients Speak Preventing Infections 2012 (opens in YouTube)
  Educational video on the importance of hand hygiene, proper equipment and technique to prevent bloodstream infections.
• Kidney Foundation: Dialysis Patient Information
  Webpage designed to provide dialysis patients with multiple resources for their active participation in dialysis care.

Additional Resources

• California Outpatient Healthcare Facilities Health and Safety Code (1200-1209), including Outpatient Dialysis Clinics
  Health and Safety Code 1205-1205.5
• California Hemodialysis Technician Training Act
  Health and Safety Code 1247-1247.9
• CMS ESRD Conditions of Participation (CoP) (PDF)
  Conditions for coverage for ESRD facilities to be certified under the Medicare Program.
• CMS CoP FAQ (PDF)
  Frequently asked questions on the conditions for coverage for ERSD facilities.
• CMS Dialysis webpage
  Basic information from Centers for Medicare and Medicaid Services (CMS), related to survey and certification of dialysis facilities.
• NIH PubMed Multidrug-resistant organisms in dialysis patients 
  Infection prevention practices recommended for dialysis facilities substantially reduce transmission and infections of MDROs in dialysis patients.​

For more information, contact HAIProgram@cdph.ca.gov​​​