IPRO End Stage Renal Disease (ESRD) Network of New England would like to notify facilities of a national initiative from the Center for Medicare & Medicaid Services (CMS) to reduce the rate of all bloodstream infections by 50% of the 2016 rate to insure better health for people in the United States living with ESRD.
Infections are the second leading cause of death in ESRD patients. The cause for a majority of these infection is catheter- related blood stream infection. As a result, CMS has developed a three part project to ensure safety and a high level of quality care to all ESRD patients.
- Reduction of Reduce Blood Stream Infections (BSI) using Center for Disease Control (CDC) core interventions for Disease Control (CDC) Core Interventions
- The reduction of Long Term Catheter (LTC) use
- Encouraging participation in a Healthcare Information Exchange (HIE) platform
The Network will be working with 50% of facilities who had the highest BSI rate reported to the National Health and Safety Network (NHSN) during the first and second quarters of 2017.
A priority of the Network is to serve as a resource to both dialysis patients and professionals throughout project activities. Open communication about existing processes, barriers, and successes are encouraged. Network staff members are interested in supplementing resources for what is working in your facility, not adding additional burden. However, in order to assess barriers, and identify how the Network can effectively meet needs of the community, completion of the ACTION REQUIRED activities (at the bottom) is essential for success of the project.
CMS Inclusion Criteria: Your facility has been selected to participate in this Quality Improvement Activity (QIA), based on the semi-annual pooled mean rates reported in NHSN for your facility during the baseline period (January through June 2017).
All facilities that have a 15% or greater long-term catheter use rate as of June 2017 will also be required to participate in activities to reduce the use of LTCs.
All facilities in this project are being encouraged to enroll in a healthcare information exchange platform.
Project Goals: Participating facilities shall demonstrate a 20% or greater reduction in the semi-annual pooled mean rate reported in NHSN for the facility from baseline to re-measurement (January through June 2018).
All facilities in this QIA with a LTC rate greater then 15% are required to demonstrate a minimum of a 2% rate reduction.
BSI Rate Reduction Activities
- Implement CDC core interventions
- Perform root cause analysis on identified barriers
- Complete NHSN training
- Partner with the CDC Making Dialysis Safer Coalition
- Appoint a patient ambassador
- Training patient to perform hand hygiene audits
LTC Rate Reduction Activities
- Appoint a Vascular Access Coordinator
- Establish peer-to-peer mentoring
- Tracking patient with LTC
- Developing a relationship with Vascular Surgeons groups
We Want to Hear from YOU!
Please contact the Quality Improvement Department if you have questions, comments, or specific barriers that you would like to address. Let us know if you have identified any best practices that you would like to share with the community.
- Input Key Facility Staff Contact Information into the Patient Safety: Healthcare-Associated Infection collection tool One contact form per facility.
- Input Key Facility Staff Contact Information into the Patient Safety: Long Term Catheter Reduction One contact form per facility.
Please be aware of the dates associated with each activity. Please complete the June Monthly Summary Report. Click here for the link to the summary report.
- View the "Five Whys Jefferson Memorial Example" Video (<2 minutes)
- Video: Environmental Cleaning and Disinfection: Dialysis
- Talk with dialysis team members and patients to identify root causes of barriers to increasing utilization of home dialysis.
- Talk with dialysis team members and patients to identify root causes of barriers decreasing LTC use
- CDC Environmental Surface Disinfection in Dialysis Facilities: Notes for Clinical Managers
- Answer questions in the Patient Safety HAI QIA Root Cause Analysis (RCA) Reporting Tool by Friday, February 9, 2018. One assessment per facility.
- The 5 Why's RCA tool by Friday, March 9, 2018 to determine root causes for a minimum of two identified barriers.
- Please complete a minimum of 10 Surface Disinfection audits and enter results into NHSN. Audit Tool:Hemodialysis station routine infection observation
Please complete the July Monthly Summary Report. Click here for the link to the summary report.
The Network is requesting that a minimum of five (5) hemodailaysis catheter exit site care audits are completed and entered into NHSN. Checklist: Hemodialysis catheter exit site care
- Join us for the Patient Safety: Healthcare-Associated Infections QIA Kick-Off Webinar to be held on Thursday, February 15, 2018 from 1:00-1:30 PM. Project requirements, activities to augment current process, and Q&A session will be available during this webinar.
- Please register for theNCC BSI QIA LAN August 7, 2018, 3:00-4:00 PM Click here to register.
- Network BSI QIA Kick- Off call: Slide Deck
- January's National Coordinating Center BSI QIA Learning and Action Network call recording
June 5, 2018 NCC Bloodstream Reduction LAN call please review the recording as soon as possible. Click here for LAN recording
In 2017 the Center for Disease Control and Prevention (CDC) updated the recommendation of the use of Chlorhexidine - Impregnated Dressing to aid in the reduction of central venous catheter. Please click on the following link to review the updated recommendations and guidelines. 2017 CDC Updates
The Network is asking that all provides review the CDC " Scrub The Hub" protocol with staff members during the month of August. Click on the following link to download the "Scrub the Hub" work sheet. Hemodialysis Central Venous Catheter Scrub-the-Hub Protocol
Tools and Resources
- Patient Poster
- Patient Fact Sheet
- Patient Brochure
- Network 1 2017 HAI Bloodstream Infections Reduction QIA
- Hemodialysis Vascular Access options Flyer
- Lifeline for a Lifetime: Planning for Your Vascular Access guide book
- FAQs about Catheter-Associated Bloodstream Infections
- Provider Poster
- Provider Fact Sheet
- Educational Courses: Hand Hygiene in Healthcare Settings - (CEU available),
- Hand Hygiene Audit Tool
- Network 1 2017 HAI Bloodstream Infections Reduction QIA
- Educate patients on the importance of preserving their current vascular access with
Provider Audit Tool:
- Catheter Connection and Disconnection Audit Tool
- Hemodialysis Catheter Connection Checklist
- Hemodialysis Catheter Disconnection Checklist
- AVF/AVG Audit Tool
- AVF/AVG Cannulation Checklist
- AVF/AVG De-cannulation Checklist