Healthcare-Associated Infections and Hemodialysis

More than 800,000 Americans live with end-stage kidney disease, and over half of them depend on dialysis as  a necessary and life-sustaining treatment. While dialysis plays a vital role in filtering and removing waste products and excess fluid from the body, it also puts patients at a higher risk for serious healthcare-associated infections. With frequent access to the bloodstream through needles or catheters, germs can enter the bloodstream, potentially leading to life-threatening infections such as bloodstream infections (BSIs) which particularly dangerous. In 2020, over 14,000 bloodstream infections occurred in U.S. patients on dialysis, with more than one-third caused by Staphylococcus aureus (staph) – a pathogen that can be challenging to treat and deadly in many cases.

Several factors contribute to the increased infection risk in dialysis patients, including:

1. Dialysis Access Type
   Vascular access is a key determinant in infection risk. Central venous catheters (CVCs), the highest-risk access type, are linked to more frequent bloodstream infections. Reducing the use of CVCs in favor of safer alternatives like arteriovenous fistulas (AVFs) can significantly lower infection rates. Monitoring infection-related events such as bloodstream infections, intravenous antibiotic starts (IVAS), and symptoms like pus, redness, or swelling (Parry-Romberg Syndrome) is crucial in managing patient safety.

2. Environmental Contamination
   The dialysis environment itself can contribute to infection if proper hygiene practices are not followed. Surfaces like dialysis machines, treatment chairs, and blood pressure cuffs must be cleaned and disinfected between patients. Bloodborne pathogens can spread easily through contaminated surfaces or equipment. Hand hygiene and the consistent use of Environmental Protection Agency (EPA)-registered disinfectants are essential in reducing this risk. Additionally, preventive biocidal surfaces can continuously and actively kill bacterial contamination on high-touch surfaces such as armrests, tables, and prep stations.

3. Waterborne Pathogens
   Dialysis facilities rely on specialized water systems for treatment, and improper water management can expose patients to waterborne infections. Following the Association for the Advancement of Medical Instrumentation (AAMI) standards ensures that water used during dialysis is safe, reducing the risk of waterborne pathogen exposure.

Preventing Infections: Healthcare Personnel and Patient Roles

Infection prevention is a collaborative effort involving both healthcare personnel and patients. Here are key steps that each group can take:

Encouraging News

There is positive news: infection rates among dialysis patients have decreased since 2014, thanks to widespread use of proven infection prevention practices. However, preventing infections across all patient populations requires a broad and equitable approach to kidney disease care, including:

• Encouraging practices that slow the progression of chronic kidney disease.
• Promoting the use of lower-risk vascular access types, such as arteriovenous fistulas (AVFs) and grafts.
• Ensuring that all dialysis facilities continue to apply proven infection prevention practices.

Dialysis treatment, while essential for patients with end-stage kidney disease, comes with an increased risk of serious infections. Bloodstream infections are a major concern, but the good news is that infection rates have been declining thanks to the implementation of proven infection prevention practices. By taking steps to address infection risks—both at the facility and patient level—and ensuring equitable access to kidney disease care across all communities, we can continue to reduce these dangerous infections and improve outcomes for dialysis patients.