"Preventing Bloodstream Infections is not only Possible, It Should be Expected"

[Hemodoc]

By Peter Laird, MD

The CDC recently announced the dramatic news that catheter based infections in the ICU's across America since 2011 are greatly reduced by the use of "Bundled" protocols of catheter insertion and preventive care saving over 1.8 billion in the last decade alone. One of the central factors to the success of the bundle is peer pressure from public reporting of each physicians outcomes.

http://www.youtube.com/watch?v=IO__W...layer_embedded

However, dialysis units have not shared this success despite the fact that bundled central lines in the ICU have been the standard of care for several years.
CDC: Too Many Infections in Dialysis Clincs

"Preventing bloodstream infections is not only possible, it should be expected,” said Thomas R. Frieden, MD, MPH, CDC director. “Meticulous insertion and care of the central line by all members of the clinical care team including doctors, nurses and others at the bedside is essential. The next step is to apply what we've learned from this to other healthcare settings and other healthcare-associated conditions, so that all patients are protected.”
The CDC is now targeting blood infections in the dialysis unit in the same manner as their program against cather associated infections in the ICU over the last several years. The steps to prevent infections are quite simple and proven over hundreds of years beginning with the simple procedure of washing your hands before doing any patient care. Unfortunately, the record on hand washing in American dialysis units is abysmal.

I am pleased to see this new focus on dialysis related infections which if implemented widely shall significantly reduce the pain and suffering of dialysis patients at the hands of those they trust with their lives simply because they don't care enough to wash their hands or change gloves between patients. As in many issues, simply taking the time to treat your patients in the same manner as you would expect is the beginning of professional health care. It is time to remember these simple truths.

http://www.hemodoc.com/2011/03/preventing-bloodstream-infections-is-not-only-possible-it-should-be-expected.html

[MooseMom]

Amen to that!!!  Yes, I would think that taking steps to prevent blood infections would be "expected." 

[RightSide]

At my own dialysis clinic, I observed protocols for preventing blood infections being violated repeatedly--often by the same repeat offenders.  For example, a tech would put on gloves, realize there was a trash can in his way, and push the trash can out of his way before handling my hemo-catheter--without either washing his hands or putting on new gloves first. 

I met with the Head Nurse of my clinic and told her what I had been observing.  She was trying to do a good job, but was unaware of this problem until I had told her about it.

[Hemodoc]

At my own dialysis clinic, I observed protocols for preventing blood infections being violated repeatedly--often by the same repeat offenders.  For example, a tech would put on gloves, realize there was a trash can in his way, and push the trash can out of his way before handling my hemo-catheter--without either washing his hands or putting on new gloves first. 

I met with the Head Nurse of my clinic and told her what I had been observing.  She was trying to do a good job, but was unaware of this problem until I had told her about it.

Dear RightSide, that has been my experience as well, but I can't give the supervisors a pass on this issue since it is their responsibility to make sure all standards are adhered to.  When I was in training I took care of a 4 start general who had just retired. Being his doctor for the moment emboldened me to ask him some questions about military command including why do you fire the Colonel when private snuffy messes up.  His answer was because the Colonel should have had the training protocols in place for private snuffy to understand his job and do it well.

The answer to difficulties in any organization can in almost all instances fall back upon the leaders of that organization. Unfortunately, there is a widespread hands off approach to hand hygiene especially in the dialysis unit. On two occasions in the two years I was incenter, I reported my concerns to the nephrologist. Without a direct, concerted effort enforced by those that oversee the clinic, this problem shall continue.

In addition, the petty retaliation that occurs to those that speak up MUST come to an end as well. It is time for the people working in the dialysis setting must act in a professional manner.