INFECTION CONTROL is an essential part of dialysis care today; yet, infections are the second leading cause of death among hemodialysis patients, according to the Centers for Disease Control and Prevention. This means dialysis providers and clinics can never let their guard down in combating infection. To learn more about the state of infection control today and what can be done to improve it, Renal Business Today asked the following renal community leaders their thoughts:
WAYNE CARLSON, Director of Clinical Affairs, Minntech Corp.
SHELLY MALAN, RN, Clinical Specialist, Alcavis HDC
PRITI PATEL, MD, MPH, Medical Epidemiologist, Centers for Disease Control and Prevention
MICHAEL ALLON, MD, Professor of Medicine at University of Alabama, Birmingham, and member of the National Kidney Foundation’s Scientific Advisory Board
Is the renal community doing a good job with infection control? Why or why not?
Allon: We do a suboptimal job with infection control. Most infections in dialysis patients are catheter-related. The proportion of patients with catheters has increased, and catheter-dependent patients have frequent bacteremia.
Malan: A good job, perhaps, but the community should strive for better reuse, patient access, hand antisepsis, disinfection of equipment and surface cleaning. I believe the best care comes from collaboration between healthcare providers and the industry to develop and use products that safeguard the patient. Manufacturers work to provide the tools that promote positive infection control outcomes while being cognizant of costs. Treatment reimbursement rates have a bearing on how a facility practices its infection control, so both the industry and provider need to use the most effective product following the most practical procedures. The new Medicare Conditions for Coverage, CDC Guidelines and state dialysis standards set forth rules specifically to avoid infection occurrences with staff and patients.
Patel: There seems to be increasing awareness of the importance of infection control in dialysis clinics, recently. There have been a lot of providers that have been very motivated, historically, to prevent infections among their patients. All of this is good news, but I would say there is still a long way to go for much of the renal community. Like many other ambulatory care settings, most dialysis clinics lack local infection control expertise. The education and training that dialysis clinic personnel receive on proper infection control practices is oftentimes inadequate. Many clinics, we think, are struggling to meet basic infection control requirements included in the new CMS Conditions for Coverage, which I think has generated this increased attention. We can and should be striving to do more than the minimum requirements to prevent infections in this population.
Carlson: Infection is one of two cause-specific reasons for hospital admission listed in the 2009 USRDS Annual Data Report, and the admission rate for infection has not markedly changed in the last seven years. With the tools available to us, we can do better than this! (In fact, with the increase in antibiotic resistance organisms, such as MRSA, VRE, C. diff., we have to do better than this!)
