Maintaining Zero Central Line-Associated Bloodstream Infections in Dialysis Catheters

Background: The Dialysis team at Lenox Hill Hospital gives high priority to preventing central line-associated bloodstream infections (CLABSI) related to hemodialysis (HD) central line catheters. In 2014, two incidences of HD CLABSIs were reported. The Dialysis team, Quality Management Department, and Infection Control held root cause analysis meetings for these cases. As a result, there was a re-evaluation of dressing kits and in-services for nursing teams were conducted on dressing changes and catheter monitoring. This resulted in a decrease of HD CLABSIs to 1 in 2015 & 2016, 0 in 2017 and 1 in 2018. The team was determined to reach 0 HD CLABSIs. In 2019, 2 new processes were added to achieve 0. Since then, there have been 0 HD CLABSIs Methods: 2 monitoring processes were created and added to the dialysis workflow. First, a daily central venous catheter (CVC) monitoring tool was created to assess and document the state a HD catheter is in. Monitoring is done daily and performed for all HD patients in the hospital regardless of the frequency of dialysis sessions. The tool includes fields for demographics, CVC type, location, date of insertion, if the dressing is intact, if the patient is allergic to chlorhexidine, and the plan of care for the site. Next, an access tracking tool to trace any access issues, the licensed provider who inserted the line or is taking care of the patient, the plan of care for the access, and communication with any long-term care facility, was created. Results: After adding the two monitoring workflows there have been 0 HD CLABSIs to date, despite having an increased amount of dialysis treatments done through a CVC. In 2019, 1367 out of 2892 total dialysis sessions were of patients with a HD CVC (47.27%). In 2023, 1405 out of 2415 had a HD CVC (58.18%). This suggests that despite the increase in volume of treatments with dialysis catheters, the monitoring workflows may have contributed to the prevention of HD CLABSIs. Conclusion: These processes may have contributed to maintaining 0 HD CLABSIs. Additional opportunities found including a deeper dive into catheter maintenance and line caregiver knowledge for home dialysis or long-term care bound patients. Recent findings show that patients discharged with home dialysis were frequently readmitted with infected dialysis catheters. These findings call for additional data analysis.