Infections are the second leading cause of death in patients with end-stage renal disease (ESRD). The majority of these infections are catheter-related bloodstream infection. As a result, the following AIM with a 5-year target has been set to guide national health promotion and management to improve the health of all people in the United States living with ESRD: by 2023, reduce the national rate of blood stream infections in dialysis patients by 50% of the blood stream infections that occurred in 2016. The Networks shall reduce the rate of blood stream infections by supporting use of National Health and Safety Network (NHSN), encouraging dialysis facility participation in the ESRD NCC HAI LAN, and assisting dialysis facilities in the implementation of the CDC Core interventions.
Click here for additional resources on Blood Stream Infection (BSI).
BSI Quality Improvement Activities
In order to focus efforts on BSI reduction, CMS has divided the work into three different task groups for facilities to be involved with. The Network has labeled these groups as cohorts 1, 2 and 3 as described below.
Defined by CMS as the facilities that have the highest 50% of all the Network BSI rates and are the lowest performing half of the Network. This cohort is considered the educational cohort. Participants are responsible to attend all educational offerings and be present on the National HAI- BSI Learning and Action Network Calls (LAN). This cohort requires an attestation to verify the implementation of the CDC CORE interventions and the verification of completion of the annual NHSN Dialysis Surveillance training.
Goal of Cohort 1: Document compliance with CDC CORE interventions.
Defined by CMS as a subset of facilities from cohort 1 who have the highest BSI rates in the Network. This is the interventional cohort. Members of Cohort 2 will be required to fulfill all requirements as listed above in Cohort 1 as well as submit project paperwork and reporting to the Network.
Goal of Cohort 2: Demonstrate a 20% or greater relative reduction in the semi-annual pooled means rate in the cohort with the highest 20% of BSIs in the Network service area.
Defined by CMS as a subset of facilities from cohort 1 who have and Long Term Catheter Rates (LTC) rate greater than 15%. This is an interventional cohort. Members of cohort 3 will be required to fulfill all requirements as listed above in Cohort 1 as well as submit project paperwork and reporting to the Network.
Goal of Cohort 3: Demonstrate a 2% reduction in the LTC in those clinics with greater than 15% LTC rate in the largest BSI cohort (50% of the network).
Research and best practices have demonstrated that units with active participation of patients as members of the health care team achieve better clinical outcomes more readily. This year, the Network is requesting that each facility in the Vocational Rehabilitation QIA designate at least one patient, or preferably, one patient per shift to take the lead on special projects. We will provide training for these patients to supervise these programs in the clinic. Patients should be viewed as role models in the unit and have the ability to lead and become "an unofficial spokesman" on the care team.
In this role, the patient will:
- Provide contact information to the Network.
- Participate in educational information web conference presentations with the Network.
- Assist with Audits and observations using tools provided by the Centers for Disease Control (CDC).
- Review educational materials designed for patients in the target facilities and throughout the Network community.
- Distribute and review resources with patients.