Reducing bloodstream infections in an outpatient hemodialysis center--New Jersey, 2008-2011.

Patients undergoing hemodialysis are at risk for bloodstream infections (BSIs), and preventing these infections in this high-risk population is a national priority. During 2008, an estimated 37,000 BSIs related to central lines occurred among hemodialysis patients in the United States. This is almost as many as the estimated 41,000 central line-associated BSIs that occurred during 2009 among patients in critical-care units and wards of acute-care hospitals. In 2009, to decrease BSI incidence in a New Jersey outpatient hemodialysis center, a package of interventions was instituted, beginning with participation in a national collaborative BSI prevention program and augmented by a social and behavioral change process to enlist staff members in infection prevention. Rates of BSIs related to the patient's vascular access (i.e., access-related BSIs [ARBs]) were evaluated in the preintervention and postintervention periods. The incidence of all ARBs decreased from 2.04 per 100 patient-months preintervention to 0.75 (p=0.03) after initiating program interventions and to 0.24 (p<0.01) after adding a behavioral change intervention. Only one ARB occurred during the last 12 postintervention months. At this hemodialysis facility, participating in a collaborative prevention program along with implementation of a behavioral change strategy was associated with a large decrease in ARBs. Other outpatient hemodialysis facilities also might reduce ARBs by adopting similar approaches to prevention.