Major articleEmbracing collaboration: A novel strategy for reducing bloodstream infections in outpatient hemodialysis centers
Section snippets
Facility
The AtlantiCare Regional Medical Center Bruce A. Eidelson, MD, Dialysis Unit is a 12-station hospital-based outpatient hemodialysis center serving patients in the Atlantic City, NJ, region. The dialysis center provides care mostly to the community's underinsured end-stage renal disease population. Prior to the interventions described in this paper, the center deployed several strategies to reduce BSIs: dialysis infection-related events surveillance through the CDC's National Healthcare Safety
Outcome measures
AR-BSIs incidence rates for the preintervention, Collaborative, and Collaborative with PD time periods ranged from 2.04 per 100 patient-months to 0.24 per 100 patient-months and varied for AR-BSIs in catheter patients from 2.94 per 100 patient-months to 1.32 per 100 patient-months. The incidence rate for AR-BSIs was significantly lower in both postintervention periods than in the preintervention period. Incidence rates for AR-BSIs in catheter patients dropped from postintervention period 1
Discussion
At AtlantiCare's outpatient hemodialysis center, implementation of a package of interventions and membership in a collaborative supported by a defined behavioral change process resulted in a lower incidence of overall AR-BSIs and AR-BSIs in patients with catheters. Notably, this included only 1 AR-BSIs for the final 12 months of the evaluation period. In addition, following implementation of PD, there were significant improvements in important infection prevention process measures. Social
Acknowledgments
The authors express deep appreciation to Alex Kallen, Priti Patel, and Ronda Sinkowitz-Cochran from CDC for their assistance with the manuscript; to CDC for establishing the BSI Prevention Collaborative and supporting the positive deviance effort at AtlantiCare; and to Jeffrey Cohn for his positive deviance consulting assistance at AtlantiCare.
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CDC provided financial support for the Collaborative, the social network analysis, and the positive deviance consulting assistance.
Study was conducted at AtlantiCare Regional Medical Center, Bruce A. Eidelson, MD, Dialysis Unit, Atlantic City, NJ.
Conflicts of interest: C. Lindberg consults with health care organizations on Positive Deviance. V. Krebs consults with organizations on social network analysis. All other authors report no conflicts.