Thursday, July 4, 2013

New CDC Recommendations Show Reduction in Bloodstream Infections by Half!

Bloodstream infections are among the most common - and most deadly - complications for dialysis patients. A recent CDC report discusses dialysis protocols that were shown to reduce infections by about half.

Many of the CDC protocol recommendations were simple: just common sense. How often we appreciate just how rare "common" sense really is!
Here are some of the main points:
  • When possible, start initial dialysis treatments via a fistula or graft - rather than a central IV line in the internal jugular vein (neck) or subclavian vein (chest).
  • Follow a checklist for dialysis procedures. The CDC gives examples of these tools.
  • Wash your hands (!).
  • Use clean gloves.
  • Use an appropriate antiseptic for cleansing the access site, e.g., chlorhexidine.
  • Apply a recommended anntimicrobial ointment to dialysis access sites.
The first point, i.e., "Fistula First!" is probably the most important.

This is because central line infections are more serious - often involving resistant bacteria such as MRSA. Central line infections are costly - and potentially deadly. Plus, they can lead to complications like infections of the heart valves (endocarditis) or the bones (osteomyelitis).

And nobody needs such complications less than a dialysis patient!

Yet, roughly 80% of dialysis patients begin their initial treatments via a central line!

In the case of my late husband, Steve, there was no other option. When first diagnosed with Chronic Kidney Disease Stage 4 (CKD-4), we thought dialysis would be years to at least months down the road.

Then a perfect storm of three calamities (dental abscess, sinus infection, and bronchitis) precipitated a free-fall into CKD-5 - over a period of only two weeks. This was way too fast for a fistula or peritoneal dialysis catheter.

But most patients don't fall into "kidney hell" as quickly as Steve did; there really can be time to plan ahead!

Please take a look at my Dialysis Patient Citizens blog, "The Patient's Voice," for more information.

If you're heading towards dialysis, give yourself every advantage. And make sure you and your dialysis center are following the CDC guidelines.

Take care,
Linda Gromko MD