DE - Dialysis Event

Infections, including bacteremia, are the second leading cause of death among hemodialysis patients. Bacteremia and localized infections of the vascular access site are common in hemodialysis patients. These and other adverse outcomes are related to the patient’s vascular access type. Common vascular access types (ordered by increasing risk of infection) include: arteriovenous (AV) fistulas created from the patient’s own blood vessels, arteriovenous grafts constructed from synthetic materials, permanent (tunneled) central venous catheters, and temporary (nontunneled) central venous catheters.

Among patients with a hemodialysis catheter, the rate of catheter-related bacteremias has been estimated to be 0.9 – 2.0 episodes per patient-year.¹  Despite efforts to increase AV fistula placements and decrease catheters, catheter use among both incident and prevalent hemodialysis patients has been steadily increasing in the U.S.²  National data also demonstrate that cause-specific hospitalization rates among hemodialysis patients have increased 29% for bacteremia and 24% for cellulitis since 1993.²

NHSN can be used to conduct infection surveillance, which is required by the Centers for Medicare and Medicaid Services (CMS) for all end-stage renal disease facilities. NHSN allows facilities to categorize hemodialysis patients by vascular access type and assess several outcomes including access-related infections, antimicrobial starts and hospitalizations. Using this information, facilities are able to calculate risk-stratified rates and compare those rates against national risk-stratified rates, and can also assess process measures such as catheter and fistula prevalence. A variety of comparison percentiles and statistical analysis options are offered including line listings, frequency tables, rates, and control charts and can be used to better inform quality improvement decisions.

References:
1- Allon. Am J Kidney Dis 2004; 44:779-91
2- U.S. Renal Data System, USRDS 2007 Annual Data Report

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