|Atlanticare Regional Medical Center|
Collaborative Interventions Reduce Bloodstream Infections in an Outpatient Hemodialysis Center
The AtlantiCare Regional Medical Center Bruce A. Eidelson, MD, Dialysis Unit is a 12-station hospital-based outpatient center serving end stage renal disease patients in the Atlantic City, NJ region.
In 2008, US hemodialysis patients had 37,000 bloodstream infections (BSIs). End stage renal patients face a BSI risk 100 times higher than that of the general population. Renal disease sufferers may increase 150% by 2020. The CDC calls BSI prevention a national priority.
The Positive Deviance Approach
The Center joined the CDC Hemodialysis BSI Prevention Collaborative in 2009 and used several strategies, including skin antisepsis and hand hygiene surveillance, but hadn’t reached the goal of fewer than one BSI per 100 patient months. In 2010 AtlantiCare leaders added Positive Deviance (PD) to engage all staff in prevention.
Staff identified shift changes as riskiest times for infection. As individual patients finished treatments, new patients entered, often waiting while disinfection regimens were hurriedly performed. Staff designed a new procedure: all stations were cleaned and disinfected at the end of each treatment, and patients entered stations at 5 AM, 10 AM and 3 PM. Wait times—which annoyed patients—were reduced and cleaning was more thorough.