A World Class Achievement of Dialysis Catheter Related Bacteremia, Single Centre Experience

Introduction:Dialysis catheter related sepsis is an important cause of morbidity and mortality among haemodialysis patients. Infection prevention in haemodialysis units is an important quality measure to ensure patient safety. It is estimated that 41,000 central line-associated bloodstream infections (CLABSI) occur in U.S. hospitals each year1. Method:We have followed WHO recommendation of the 5 moment hand hygiene during health care, figure 1. This process was strictly monitored among all dialysis unit staff including doctors, nurses, allied health care professional and any visitors dealing with patients in the dialysis unit. A vigorous staff directed education was given to the involved staff whenever any drop in compliance is detected, figure 2.

Nurses Others doctors Total50%

60%

70%

80%

90%

100% 98.40% 92.59% 97.78% 96.88%

Results:From December 2012 till the end of 2015, Al Wakra Hospital dialysis unit experienced a significant increase in the workload. During this period the unit recorded 17,362 dialysis sessions. By the end of 2015, 5405 dialysis session were performed through central catheters. The remaining sessions were done through arterio-venous fistulae and grafts. During this period, only two cases of dialysis catheter related bacteraemia were reported. The two cases were attributed to failure of patients to follow the recommended procedure of catheter care at home. Table 1: Percentage of patients with dialysis catheters during different years, total number of dialysis sessions and bacteraemia episodes. Year 2013 2014 2015Number of conducted dialysis Sessions

3119 6318 7841

Number of dialysis sessions through catheters

1353 1817 2151

Percentage of Patients with catheters

52% 36% 35%

Number of Bacteraemia Events 0 2 0Conclusion: Investing in staff hand hygiene is a very important area for improving dialysis unit quality of care. Implementation of a strict unit vascular access care protocol and continuous staff monitoring and education can culminate in achieving a great results for dialysis catheter related bacteremia. Basic and cheap to apply tools can still play an important and effective role in improving care and reducing morbidity and mortality among hemodialysis patients.

Figure 1: 5 Moments of Hand Hygiene as recommended by The WHO 2

Figure 2: Example of hand hygiene compliance monitoring during the month of February 2014 showing drop among allied

health worker required intervention by further education