healthcare-associated infections (HAI) program

Preventing Bloodstream Infections in Hemodialysis Patients

Bloodstream Infections (BSI) are dangerous complications and leading cause of death in hemodialysis patients. This webpage provides resources and guidance to California health care personnel and the dialysis community, infection prevention guidelines and recommendations, clinician and patient education, hemodialysis clinic infection prevention tools, and the use of the National Healthcare Safety Network (NHSN) for monitoring progress in reducing BSI in dialysis clinics in California.

Infection Prevention Guidelines and Recommendations

CDC Approach to BSI Prevention in Dialysis Facilities (PDF)
Nine core interventions to prevent dialysis-related BSI.
CDC Infection Control Requirements for Dialysis Facilities and Clarification Regarding Guidance on Parenteral Medication Vials
CDC recommendations on parenteral medication and clarification on the inclusion of bloodborne viral infection.
CDC Guide to Infection Prevention for Outpatient Settings: Minimum Expectations for Safe Care
Infection Prevention checklist for Outpatient Settings.
CDC Infection Prevention Checklist for Outpatient Settings: Minimum Expectations for Safe Care (PDF)
Infection Prevention checklist for Outpatient Settings.
CDC 2011 Guidelines for the Prevention of Intravascular Catheter-Related Infection
Evidenced-based recommendations for preventing intravascular catheter-related infections.
Cambridge Core: Infection Control & Hospital Epidemiology | Strategies to prevent central line-associated bloodstream infections in acute-care hospitals: 2022 Update
CLABSI prevention practice recommendations from the 2022 Compendium.

Infection Prevention Education

CDC Provider Training Video: Preventing Bloodstream Infections in Outpatient Hemodialysis Patients: Best Practices for Dialysis Staff (PDF)
Best practices for dialysis staff for prevention of bloodstream infections in patients receiving hemodialysis.
CDC Continuing Education Course: Infection Prevention in Dialysis Settings
Continuing education for infection prevention in dialysis settings for healthcare workers.
AHRQ Safety Program for End-Stage Renal Disease Facilities – Toolkit
Four instructional modules that a facilitator can use to teach dialysis center team members specific ways to create a culture of safety and prevent healthcare-associated infections in dialysis patients. Created by Agency for Healthcare Research and Quality (AHRQ) for End-Stage Renal Disease (ESRD) clinics.

Infection Surveillance, Prevention Strategies and Best Practices

CDC NHSN Tracking Infections in Outpatient Dialysis Facilities
NHSN training and support material for reporting dialysis events, process measures and data analysis.
CDC NHSN Dialysis Event Surveillance Protocol
Dialysis event definitions and event surveillance protocol
CDC Best Practices for Bloodstream Infection Prevention in Dialysis Setting | Dialysis Safety
Core interventions for bloodstream infection prevention in outpatient dialysis centers including resources for staff education and implementation.
CDC Preventing Bloodstream Infections in People on Dialysis | VitalSigns
Preventing infections among patients receiving dialysis from all racial, ethnic, and socioeconomic groups.
CDC Strategies for Improving Antibiotic Use in Outpatient Hemodialysis Facilities | Antibiotic Prescribing and Use
APIC Infection Prevention and Control in Dialysis Settings (2022)
Updated guide for dialysis setting on the fundamentals for understanding kidney disease, standard and transmission-based precautions, and best practices for keeping hemodialysis patients safe from infection.

Checklists, Posters, and Tools for Use in Dialysis Clinics

CDC Making Dialysis Safer for Patients Coalition
A collaboration of dialysis organizations promoting the use of CDC’s core interventions and resources to prevent bloodstream infections among hemodialysis patients.
CDC Provider Poster: Put Together the Pieces to Prevent Infections in Dialysis Patients (PDF)
Illustration of the components of infection prevention for dialysis patients.
WHO 5 Moments for hand Hygiene in Hemodialysis Poster (PDF)
Poster that illustrates how to perform hand hygiene when working with dialysis patients.
CDC Protocol: Scrub-the-Hub for Hemodialysis Catheters (PDF)
Suggested approach to disinfecting catheter hubs prior to access for hemodialysis.
CDC Hand Hygiene Observations Tool (PDF)
Data collection tool for hand hygiene compliance observations in the dialysis setting.
CDC Checklist: Dialysis Station Routine Disinfection (PDF)
Checklist for routine disinfection of dialysis station when there is no visible blood or soil.
CDC Audit Tool: Hemodialysis station routine disinfection observations (PDF)
Audit tool for routine disinfection of dialysis station when there is no visible blood or soil.
CDC Checklist: Hemodialysis catheter connection (PDF)
Checklist of steps to safely connect a hemodialysis catheter to blood lines.
CDC Checklist: Hemodialysis catheter disconnection (PDF)
Checklist of steps to safely disconnect a hemodialysis catheter from blood lines.
CDC Audit Tool: Catheter connection and disconnection observations (PDF)
Audit tool for connection and disconnection of hemodialysis catheter to a blood lines.
CDC Checklist: Hemodialysis catheter exit site care (PDF)
Checklist for safe catheter exit site care for patients with a central venous catheter for dialysis access.
CDC Audit Tool: Catheter exit site care observations (PDF)
Audit tool for hemodialysis catheter exit site care.
CDC Checklist: Arteriovenous fistula/graft cannulation (PDF)
Checklist of steps on how to safely perform fistula/graft cannulation and connect to blood lines.
CDC Checklist: Arteriovenous fistula/graft decannulation (PDF)
Checklist of steps on how to safely perform fistula/graft de-cannulation and disconnection from blood lines.
CDC Audit Tool: Arteriovenous fistula/graft cannulation observations (PDF)
Audit tool on how to safely perform fistula/graft cannulation and connect to blood lines
CDC Checklist: Hemodialysis injectable medication preparation (PDF)
Checklist of steps for aseptic injectable medication preparation and administration.
CDC Dialysis Audit Tool: Hemodialysis Injectable medication preparation (PDF)
Audit tool for healthcare workers of safe injection practice.
CDC Injection Safety Checklist (PDF)
Checklist to remind healthcare workers of safe injection practice.

Information for Dialysis Patients

CDC Speak Up: Making Dialysis Safer for Patients Video (Opens in YouTube)
This video follows the journey of two patients on dialysis who feel empowered to speak up and share concerns about their treatment in order to prevent infections.
CDC Comic: Engaging Patients in the Infection Prevention Conversation (PDF)
Provides helpful tips and reminders about patient and caregiver engagements.
CDC Patient Pocket Guide: 6 Tips to Prevent Dialysis Infections (PDF)
Pocket sized guide for hemodialysis patients with tips on how to prevent infections.
CDC: Infection Control and Bloodstream Infection Prevention: The Perspective of Patients Receiving Hemodialysis (PDF)
Focus group for patients taking a role in infection prevention.
CDC Infections and Patients on Dialysis | Dialysis Safety (PDF)
Steps for dialysis patients to take to prevent infections while receiving hemodialysis
ESRD Network: Dialysis Patients Speak: a Conversation about the Importance of AV Fistulas (opens in YouTube)
Educational video on hemodialysis patients speaking about the importance of AV fistulas for vascular access.
ESRD Network: Dialysis Patients Speak Preventing Infections 2012 (opens in YouTube)
Educational video on the importance of hand hygiene, proper equipment and technique to prevent bloodstream infections.
Kidney Foundation: Dialysis Patient Information
Webpage designed to provide dialysis patients with multiple resources for their active participation in dialysis care.

Additional Resources

California Outpatient Healthcare Facilities Health and Safety Code (1200-1209), including Outpatient Dialysis Clinics
Health and Safety Code 1205-1205.5
California Hemodialysis Technician Training Act
Health and Safety Code 1247-1247.9
CMS ESRD Conditions of Participation (CoP) (PDF)
Conditions for coverage for ESRD facilities to be certified under the Medicare Program.
CMS CoP FAQ (PDF)
Frequently asked questions on the conditions for coverage for ERSD facilities.
CMS Dialysis webpage
Basic information from Centers for Medicare and Medicaid Services (CMS), related to survey and certification of dialysis facilities.
NIH PubMed Multidrug-resistant organisms in dialysis patients
Infection prevention practices recommended for dialysis facilities substantially reduce transmission and infections of MDROs in dialysis patients.