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CMS ESRD QIP Rule
Dialysis InfectionsA leading cause of death among hemodialysis patients, second only to vascular disease, bloodstream and other types of infections are a significant threat to patient safety. CDC helps the dialysis community prevent infections by providing evidence-based guidelines and access to the National Healthcare Safety Network (NHSN), a surveillance system that allows facilities to track infections. These resources are critical for tracking and preventing infections and for evaluating the effectiveness of a specific infection prevention effort.
In 2008, CDC estimated that 37,000 bloodstream infections occurred among hemodialysis patients with central lines. One in four of these infected patients may have died as a result of the infection. Since 1993, hospitalization rates among hemodialysis patients have increased 47% for bloodstream infection and 87% for vascular access infection.
The Burden and RiskHealthcare providers including doctors, nurses, and technicians can prevent many of these infections by following basic infection prevention recommendations and tracking rates.
A patient’s risk of infection is related to their vascular access type (how a patient’s veins are accessed so they can receive hemodialysis). Common types include: central lines, arteriovenous (AV) fistulas created from the patient’s own blood vessels, and AV grafts constructed from synthetic materials.
Whenever possible, AV fistulas are the preferred way to receive dialysis because they have the lowest risk of infection. Central lines have the highest infection risk.
NHSN Surveillance Informs PreventionTracking infections can identify which patients are at risk or which part of a facility needs improvement. In addition, surveillance allows CDC to see national trends and direct prevention efforts for the country.
Information collected includes process measures, such as the number of catheters and fistulas used, and outcomes such as infections. This information can be used to evaluate and improve performance locally, statewide, and nationally.
In addition to allowing facilities to categorize hemodialysis patients by type of vascular access used, NHSN provides a variety of analysis options including line listings, rate tables, and control charts, which can be used to better inform quality improvement decisions.
Recently, the Centers for Medicare and Medicaid Services (CMS) published a final rule encouraging all end stage renal disease (ESRD) facilities to track quality indicators through NHSN by following the Dialysis Event Protocol. Facilities must comply with the rule to receive full payment through the CMS Prospective Payment System (PPS) ESRD Quality Incentive Program (QIP).
Go to cms.gov for more information about the CMS rule or to join NHSN to report dialysis event information.
- FAQs about Dialysis Event Reporting
- FAQs about NHSN and CMS ESRD QIP Rule
- FAQs about NHSN reporting with CDA – General and dialysis event reporting [PDF - 181 KB] December 2011.
- Dialysis Event Protocol [PDF - 121 KB] February 2012
Guidelines and procedures for monitoring.
- NHSN Enrollment for Outpatient Dialysis Facilities (23:20)
Available for download Enrollment for Outpatient Dialysis Facilities slide set [PDF - 2.01 MB]
- Required only for the person enrolling the facility, users who are added after the facility is enrolled should review the remaining requirements.
- Other Enrollment Resources
- NHSN Set-up for Outpatient Dialysis Facilities (13:29)
Available for download NHSN Set-up for Outpatient Dialysis Facilities slideset [PDF 1.04 MB]
- Required for all users with administrative rights participating in Dialysis Event surveillance.
- Understanding Surveillance Requirements [PDF - 5.21 MB]
- Required for all users participating in Dialysis Event surveillance.
- Reading the Dialysis Event Protocol [PDF - 342 KB] June 2011 is a required part of training.
- Enrolling Multiple Outpatient Dialysis Clinics in NHSN [PDF - 17 pages]
- Joining a Group and Conferring Rights for Outpatient Dialysis [PDF - 890 KB]
Forms and Instructions
- 57.106 Patient Safety Monthly Reporting Plan [PDF - 56 KB] February 2012
Outpatient Dialysis Facility Enrollment and Annual Survey
- 57.104 Outpatient Dialysis Center Practices Survey [PDF - 81 KB] January 2012 only used if enrolling facility is an outpatient dialysis center.
- Customizable form [DOC - 43 KB] January 2012
- 57.109 Dialysis Event [PDF - 106 KB] January 2012
Patient Census Form
- 57.119 Denominators for Outpatient Dialysis Census Form – completed once per month [PDF - 33 KB] January 2012