ISR 69 - Preventing Pediatric Outpatient Hemodialysis Morbidity: Implementing the Use of Needleless Connectors and Prevention Process Measures Audits to Reduce Bloodstream Infections

Background: Pediatric outpatients receiving hemodialysis (HD) through central venous catheters (CVC) are at an elevated risk for bloodstream and localized access site infections with substantial morbidity. We wanted to determine if implementing the use of a closed system and staff conducting audits of dialysis prevention process measures (PPM) would decrease the frequency of bloodstream infections (BSI) and adverse outcomes.

Methods: We conducted a gap analysis of dialysis event bloodstream infection prevention opportunities and a literature review of needleless connectors to create a closed system. After a value analysis of adding the needleless connector and training staff to conduct PPM audits were completed, a trial began in January 2020. Pediatric outpatients receiving hemodialysis through a CVC had a needleless connector added to the end of the arterial and venous blood lines. Staff conducted audits following the PPM audit tool. Monthly surveillance was completed to identify dialysis events and outcomes.

Results: After one year, the CVC BSI rate decreased from 16.95 per 100 patient-months in 2019 to 5.5 per 100 patient-months in 2020. Hospital admissions associated with BSIs decreased from 14 in 2019 to 5 in 2020. The number of BSIs with a loss of vascular access outcome decreased from 5 in 2019 to 3 in 2020.

Conclusions: The use of needleless connectors and staff conducting PPM audits ensuring best practices led to a sustained reduction of BSIs in pediatric outpatients receiving HD through CVCs. Prevention of BSIs among chronic HD patients reduces the frequency of antimicrobial treatments, hospital admissions, and loss of vascular access.