Infection Prevention and Outbreak Control in Dialysis Settings

August 28, 2019 | ASTHO Staff

End-stage renal disease patients are at an increased risk for acquiring infections related to their healthcare. Working with home care providers and other partners, state and territorial public health departments can support infection prevention and control practices in all settings where patients receive dialysis treatment.

“Outbreaks in dialysis settings often occur as a result of lapses in infection control practices,” says Priti Patel, medical officer in CDC’s Division of Healthcare Quality Promotion and lead for the Making Dialysis Safer for Patients Coalition, which brings together multidisciplinary stakeholders, including public health and healthcare partners, to promote CDC’s core interventions and resources to prevent bloodstream infections associated with dialysis. “Additionally, patients receiving dialysis treatment at home have potentially unique public health and infection prevention needs related to the home environment.” Patel emphasizes that “public health departments are essential partners on the frontlines of outbreak response and infection prevention, and although public health staff may not typically have experience in the dialysis setting, CDC has tools and resources that can help staff become familiar with practices and procedures prior to an outbreak occurring.”

ASTHO spoke with Jeanne Negley, healthcare-associated infection program surveillance director at the Georgia Department of Public Health and member of the Making Dialysis Safer for Patients Coalition, about the role health departments can take in making dialysis settings safer, as well as her experience in addressing infection control and outbreak response in dialysis settings.

How can public health stakeholders partner with dialysis providers to address infection control and outbreak response associated with dialysis?

Health departments can invite dialysis providers and the End Stage Renal Disease Network to join its Healthcare-Associated Infections Advisory Board. This allows providers to engage in statewide initiatives and expand awareness and application of dialysis prevention in outpatient and inpatient centers. The Georgia Department of Public Health has also offered infection control training to dialysis providers in collaboration with the Dogwood American Nephrology Nurses Association chapter and the Southeast Kidney Council.

What best practices do you recommend for health departments working in dialysis settings?

Contact a dialysis center in your jurisdiction and ask them if you can visit their facility and observe their work. Use the checklists provided by CDC’s Making Dialysis Safer for Patients Coalition to observe and learn about infection prevention and control in the dialysis setting. This practice can benefit both novice and experienced health department professionals. After gaining an appreciation for infection prevention in this setting, join the Making Dialysis Safer for Patients Coalition and commit to posting its materials, convening an educational session, and integrating the program materials into your state prevention program activities.

What are the monitoring and surveillance challenges for health departments tracking infections and outbreaks related to dialysis?

One challenge for conducting surveillance with dialysis centers is that there so many of them! Health departments can address this challenge by developing relationships with dialysis corporations and reaching out to independent dialysis facilities to ensure that all dialysis facilities in the jurisdiction understand the requirements of notifiable disease reporting and the role of public health to prevent and respond to outbreaks.

What future role might health departments play in infection prevention and control for home dialysis and other dialysis treatment settings?

Health departments can support the reduction of bloodstream infections in the dialysis setting through education, leading collaboratives, and promoting infection prevention resources by participating in the Making Dialysis Safer for Patients Coalition. Audit tools, checklists, and other resources available through the coalition can be adapted to improve patient safety in the home hemodialysis setting. Health departments can also support the promotion, application, and use of these resources through its jurisdictional partners, such as the End Stage Renal Disease Network, state hospital association, quality improvement organizations, healthcare and health system providers, and patient safety organizations.