Authors: (including presenting author): :
Lo YM(1), Pang YKC(1), Lai WMY(1), Leung YH(1), Lam YW(1), Ho HSE(2), Lai WS(2)
Affiliation: :
(1)Infection Control Team, Pamela Youde Nethersole Eastern Hospital (2)Renal team, Pamela Youde Nethersole Eastern Hospital
Keyword 1: :
Dialysis event surveillance
Keyword 2: :
Haemodialysis Center
Keyword 3: :
Bloodstream infections
Keyword 4: :
Access-related infections
Keyword 5: :
Local access-site infections
Introduction: :
Patients receiving haemodialysis (HD) are at elevated risk of bloodstream infections and vascular access-site infections, which can lead to severe complications, prolonged hospitalization, and increased mortality. The US Centers for Disease Control and Prevention recommends protocol-driven surveillance of infection rates in HD patients, and Hong Kong’s Centre for Health Protection encourages hospitals to implement targeted surveillance in dialysis centers to identify preventable risk factors. However, no standardized surveillance protocol is available, and data on access-related infection rates were lacking locally, hindering targeted quality improvement initiatives.
Objectives: :
To establish continuous monitoring of access-related infections in the HD center, with aims to detect infections and identifying modifiable risk factors to guide infection prevention strategies
Methodology: :
In collaboration with Renal Team, Infection Control Team (ICT) adopted the US National Healthcare Safety Network (NHSN) Dialysis Event Surveillance Protocol for local use. The programme started from November 2023 to December 2024, prior to the launch of the corporate-wide protocol in January 2025. After discussion and delineation of shared responsibilities, renal team would be responsible for providing monthly patient counts by vascular access type to estimate patient-months as denominators. ICT applied NHSN definitions to identify dialysis events (DE), bloodstream infection (BSI), access-related BSIs (ARBSI), and local access-site infections (LASI). A joint agreement would be achieved before confirming any access-related infection.
Result & Outcome: :
Non-tunneled central venous catheters were identified as a major risk factor for infections in interim analysis after the first six months of programme. In May 2024, a multidisciplinary improvement plan was developed and implemented, including restrictions on the duration of non-tunneled catheter use and standardization of skin antisepsis protocols.
Over the full 14-month period (1,319 patient-months), 43 DEs were identified (3.26 per 100 patient-months), including 27 BSIs (2.05 per 100 patient-months) of which 14 were ARBSIs (1.06 per 100 patient-months), and 16 LASIs (1.21 per 100 patient-months).
Post-intervention, mean BSI incidence decreased by 23.9% (from 2.05 to 1.56 per 100 patient-months), mean ARBSI rates fell by 41.5% (1.06 to 0.62 per 100 patient-months), and LASI rates showed a significant 93.4% reduction (1.21 to 0.08 per 100 patient-months).
