AHRQ Safety Program for End-Stage Renal Disease Facilities

This is an ongoing project that will result in a toolkit to help End-Stage Renal Disease clinics prevent healthcare-associated infections in dialysis patients.

In 2007, 12 percent of U.S. dialysis patients were hospitalized due to septicemia, and 16 percent of all U.S. dialysis patients died of some kind of infection. Many of these infections are preventable through the use of evidence-based infection control practices not uniformly practiced in U.S. dialysis facilities.

To address this problem, the Agency for Healthcare Research and Quality (AHRQ) funded a 2-year project called National Opportunity To Improve Infection Control in ESRD (NOTICE) to develop and implement resources that will help dialysis facilities reduce infections. The project aims to—

Reduce vascular access infections,
Enhance infection control best practices among clinicians, and
Improve safety culture using AHRQ’s Comprehensive Unit-based Safety Program (CUSP) framework.

This is an ongoing project. It is expected to end in fall 2014.

After the project ends, a toolkit of science-based and practical resources will be publicly available. These materials will reflect the real-world experiences of the frontline providers who participated in this project.

For more information on the project, see below.

About the project and materials available now for use
Project partners
For participants [http://www.notice-initiative.org/ ]

Project and Available Resources

This is an ongoing project that brings together subject matter experts and dialysis providers to develop field-tested resources to reduce infections in dialysis patients. The project is based on a group of materials called a change package. The change package helps facilities implement CHARGE, which stands for—

Culture of Safety
Hand Hygiene
Access Site (Preparation/Cleansing)
Reduce and Remove Catheters
Great Connection and Disconnection
Evaluation

The change package consists of eight modules. Each module is meant to be delivered as part of a half-hour to 1-hour staff presentation. The modules are—

Project Overview
Data Measurement
Leveraging Data
Clinical Care of the Hemodialysis Patient Module One
Clinical Care of the Hemodialysis Patient Module Two
Culture of Safety Module One
Culture of Safety Module Two
Patient Engagement

The change package is not complete yet, but several pieces have been developed. These pieces provide a basic understanding of quality improvement and infection control processes. These materials will be refined and finalized into a toolkit at the end of this project, but some ESRD clinics may find the information below useful now.

Resources

Video Vignettes

Four companion video vignettes were created to supplement the change package. Below are three available now as standalone videos.

Initiating Dialysis With Fistula or Graft: Accessing Medication Port To Administer Medication
This video vignette illustrates proper initiation of dialysis for patients with fistulae or grafts and the way to properly administer medication. It can be shared with staff as a refresher on current practices and guidelines.

Initiating Dialysis With a Catheter: Catheter Exit Site Care
This video vignette illustrates proper initiation of dialysis for patients with catheters and exit site care. It can be shared with staff as a refresher on current practices and guidelines.

Fostering a Culture of Safety
This video vignette shows a fictional scenario in which a positive culture of safety overcomes multiple commonly seen barriers to infection prevention in dialysis facilities.

Infection Control Checklists

The infection control checklists were created to help facilities perform audits. They can be used as a bundle or individually to help reduce infections in facilities by increasing awareness of specific issues for facilities to focus on in their Quality Assurance and Performance Improvement process.

Infection Control Checklists (PDF) [

- 780.2 KB]

Project Partners

The National Opportunity To Improve Infection Control in ESRD (NOTICE) project is being conducted through a partnership that brings together subject matter experts and providers in the field. Partners for this project include—

Health Research and Educational Trust

HRET provides overall administration and support for the project.

University of Michigan – Kidney Epidemiology Cost Center

UM-KECC's role in the project is to leverage its clinical, infection control and analytical expertise to lead or facilitate various phases

Renal Network of the Upper Midwest (Renal Network 11)

Renal Network 11 provides the perspective of the dialysis facilities at all stages of the project. This includes leading the recruitment of dialysis facilities to participate in the project.

Southeastern Kidney Council, Inc. (Renal Network 6)

This network is responsible for coaching and support for half of the facility teams enrolled in the project. This includes recruiting facilities, working with facilities to ensure call attendance and data submission, and serving as an advisor to teams.