National healthcare safety network (NHSN) dialysis event surveillance report for 2014

Abstract

Background and objectives Persons receiving outpatient hemodialysis are at risk for bloodstream and vascular access infections. The Centers for Disease Control and Prevention conducts surveillance for these infections through the National Healthcare Safety Network. We summarize 2014 data submitted to National Healthcare Safety Network Dialysis Event Surveillance. Design, setting, participants, & measurements Dialysis facilities report three types of dialysis events (bloodstream infections; intravenous antimicrobial starts; and pus, redness, or increased swelling at the hemodialysis vascular access site). Denominator data consist of the number of hemodialysis outpatients treated at the facility during the first 2 working days of each month.We calculated dialysis event rates stratified by vascular access type (e.g., arteriovenous fistula, arteriovenous graft, or central venous catheter) and standardized infection ratios (comparing individual facility observed with predicted numbers of infections) for bloodstream infections. We described pathogens identified among bloodstream infections. Results A total of 6005 outpatient hemodialysis facilities reported dialysis event data for 2014 to the National Healthcare Safety Network. These facilities reported 160,971 dialysis events, including 29,516 bloodstream infections, 149,722 intravenous antimicrobial starts, and 38,310 pus, redness, or increased swelling at the hemodialysis vascular access site events; 22,576 (76.5%) bloodstream infections were considered vascular access related. Most bloodstream infections (63.0%) and access-related bloodstream infections (69.8%) occurred in patientswitha centralvenous catheter.The rate of bloodstreaminfectionsper 100patient-monthswas 0.64 (0.26 for arteriovenous fistula, 0.39 for arteriovenous graft, and 2.16 for central venous catheter).Other dialysis event rates were also highest among patients with a central venous catheter. Facility bloodstream infection standardizedinfection ratio distribution was positively skewed with a median of 0.84. Staphylococcus aureus was the most commonly isolated bloodstreaminfection pathogen (30.6%), and39.5%of S. aureus isolates testedwere resistant to methicillin. Conclusions The 2014 National Healthcare Safety Network Dialysis Event data represent nearly all United States outpatientdialysis facilities. Rates of infectionandother dialysis eventswerehighest amongpatientswitha central venous catheter comparedwith other vascular access types. Surveillance data can help define the epidemiology of important infections in this patient population.