Infection Prevention

Power Hour Breakout

(L5) Reducing Central Line-Associated Bloodstream Infections for Hemodialysis Patients: How Antiseptics Can Make the Difference.

Presenter(s)

• 

  Joan Hebden, RN, MS, CIC, FAPIC

  President: Infection Prevention Consultant
  IPC Consulting Group LLC

  PDI, Inc: Consultant (Status: Ongoing), Speaker's Bureau (Status: Ongoing)

Hemodialysis patients with a central line as opposed to an arteriovenous shunt or fistula represent 70% of the access-related bloodstream infections seen in this population, of which, 31% are caused by Staph aureus. Recent studies have found that the use of chlorhexidine for hub disinfection, either by scrubbing the hub or use of an impregnated cap, significantly reduced CLABSIs. Prior studies have found that hemodialysis patients colonized with Staph aureus have the same strain in their nose and on their hands suggesting that self-inoculation of vascular access sites may contribute to the occurrence of Staph aureus bacteremia. Historically, mupirocin - a topical antibiotic - has been studied for nasal decolonization and has been found to lower the risk of S. aureus BSI among colonized patients. However, due to concerns regarding mupirocin-resistant strains of Staph aureus, poor patient compliance, and cost, nasal decolonization with antiseptics, such as povidone-iodine, is gaining popularity.

Learning Objectives:

• Define the risk of bloodstream infection for hemodialysis patients with a central venous catheter.
• State the primary pathogen responsible for CLABSI among hemodialysis patients.
• Discuss the use of chlorhexidine for catheter hub disinfection.
• State how nasal decolonization contributes to bloodstream infection reduction for hemodialysis patients.
• List the reasons that nasal decolonization with antiseptics is preferred to mupirocin.