Part of a broader rule [The Office of the Federal Register (OFR)], CMS now requires dialysis facilities to submit three months of 2012 infection and antibiotic use data to CDC’s National Healthcare Safety Network [CDC - NHSN] in order to receive full Medicare payment. This is the first CMS/CDC data collaboration related to dialysis settings, however, the two agencies have been aligning patient safety efforts on hospital quality measures including CLABSI (CDC - Healthcare-associated infections - HAI), SSI, and CAUTI.
CDC is providing several new resources to dialysis facilities and patients to ensure smooth NHSN enrollment and improved quality care. These include a new dialysis safety web site (CDC - Dialysis Safety in Healthcare Settings) including infection prevention recommendations, as well as step-by-step NHSN enrollment and training materials
To read the CMS rule, visit http://www.ofr.gov/OFRUpload/OFRData/2011-28606_PI.pdf
To enroll a dialysis facility in NHSN, visit http://www.cdc.gov/nhsn/dialysis/cms-dialysis-enroll-steps.html
To view new CDC dialysis safety website, visit: http://www.cdc.gov/dialysis/
CDC - Healthcare Provider Basics - Dialysis Safety
Healthcare Providers
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Overview
Reducing healthcare-associated infections (HAIs) is a national priority. Healthcare providers (HCPs) have made incredible efforts to prevent these infections in intensive care units and other inpatient settings. That same commitment to prevention must be applied in outpatient settings such as dialysis clinics.In 2008, hemodialysis patients experienced approximately 37,000 central-line associated bloodstream infections (CLABSIs). Within the past 10 years, there have been more than 30 outbreaks of hepatitis B and hepatitis C in non-hospital healthcare settings such as outpatient clinics, dialysis centers, and long-term care facilities. The reduction and ultimate elimination of HAIs in dialysis settings (CLABSIs) requires a partnership between many stakeholders; however, clinicians are ultimately responsible for ensuring every patient receives safe care.
CDC provides a recommended set of interventions to prevent bloodstream infections (BSI) in hemodialysis patients
[PDF - 529KB]. These recommendations are already being implemented by a group of dialysis providers in collaboration with CDC. This partnership, known as CDC’s Dialysis BSI Prevention Collaborative, was established to allow facilities to share best- and evidence-based practices to prevent BSIs. Results are measured using CDC’s HAI surveillance system, the National Healthcare Safety Network (NHSN). The Collaboration includes freestanding and hospital-based facilities. Please contact cdcinfo@cdc.gov for more information.Basic steps clinicians can take to prevent infections in hemodialysis patients include:
- Promote fistula use
- Get catheters out
- Improve catheter care
- Clean hands before and after every patient contact
- Talk to patients about good vascular access care
Guidelines and Recommendations
- CDC. Infection Control Requirements for Dialysis Facilities and Clarification Regarding Guidance on Parenteral Medication Vials. MMWR 2008;57(32);875–6.
- Siegel JD, Rhinehart E, Jackson M, et al. the Healthcare Infection Control Practices Advisory Committee (HICPAC). Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings, 2007
- CDC. Guidelines for Environmental Infection Control in Health-Care Facilities. MMWR 2003; 52(RR10):1–42.
- Guidelines for the Prevention of Intravascular Catheter-Related Infections. HICPAC 2011.
- CDC. Boyce JM, Pittet D. Healthcare Infection Control Practices Advisory Committee (HICPAC). Guideline for Hand Hygiene in Health-Care Settings
- Recommendations for Preventing Transmission of Infections Among Chronic Hemodialysis Patients
Clinical Practice Consensus Guidelines
- Fingerhut D, Fiorarancio M, Milburn R, et al. National Kidney Foundation -KDOQI. Clinical Practice Guidelines and Clinical Practice Recommendations 2006.
Clinical Practice Guidelines for Peritoneal Dialysis Adequacy Update 2006. - Warady BA. Guidelines for the Treatment of Peritonitis in Children. Perit Dial Int 2000;20:607.
- Keane WF, Bailie GR, Boeschoten E, et al. ISPD Guidelines/Recommendations: Adult Peritoneal Dialysis-Related Peritonitis Treatment Recommendations: 2000 Update. Perit Dial Int 2000;20(4): 396–411
- Gokal R, Alexander S, Ash S, et al. International Society for Peritoneal Dialysis. Peritoneal Catheters and Exit Site Practices Toward Optimum Peritoneal Access: 1998 Update.
Immunizations
- CDC. Guidelines for Vaccinating Kidney Dialysis Patients and Patients with Chronic Kidney Disease.
- STIC: The Safe and Timely Immunization Coalition
This national coalition consisting of healthcare professionals and patients with end stage renal disease (ESRD) was formed in 2005 to increase the rate of hepatitis B, influenza, and pneumococcal immunizations in patients and staff in dialysis settings.- ESRD Network 6.
Safe and Timely Immunization Coalition (STIC): A Comprehensive Resource Guide of Educational Materials on Hepatitis B, Influenza, and Pneumococcal Immunizations.
- ESRD Network 11.
- ESRD Network 15.
- ESRD Network 6.
Centers for Medicare and Medicaid Services (CMS) Conditions and Interpretive Guidance
- Centers for Medicare & Medicaid Services. 42 CFR Parts 405, 410, 413 et al. Conditions for Coverage for End Stage Renal Disease Facilities . Federal Register 2008;73(73):20370–20484.
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