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Last Updated 7/11/10
   

Infection control is a responsibility of everyone involved with the dialysis treatment process. This resource page provides the latest information on infection control issues from the Centers for Disease Control and Prevention (CDC) as well as the dialysis-specific scientific journals.

Chronic hemodialysis patients are at high risk for infection because the process of hemodialysis requires vascular access for prolonged periods. In an environment where multiple patients receive dialysis concurrently, repeated opportunities exist for person-to-person transmission of infectious agents, directly or indirectly via contaminated devices, equipment and supplies, environmental surfaces, or hands of personnel. Furthermore, hemodialysis patients are immunosuppressed, which increases their susceptibility to infection, and they require frequent hospitalizations and surgery, which increases their opportunities for exposure to nosocomial infections. Bacterial infections, especially those involving vascular access, are the most frequent infectious complication of hemodialysis and a major cause of morbidity and mortality among hemodialysis patients.

RenalWEB has a separate Hepatitis Page for all hepatitis-related issues.

Warning: Changes should never be made in a patient's treatment or care based solely on the information found here.  All patients have unique healthcare concerns and considerations and these must all be taken into account before any changes can be safely made.  All medical and therapeutic decisions must come from a qualified health care provider.  Read RenalWEB's Legal Disclaimer before proceeding.

  NEWS AND LATEST ARTICLES

Infection-Related Hospitalizations in Older Patients With ESRD - Article in press abstract from NDT. - July 9, 2010
Hospitals warned that wet breathing system filters transmit harmful bacteria and yeast - Article from Wiley-Blackwell. - July 6, 2010
High frequency of ulcers, not associated with Helicobacter pylori, in the stomach in the first year after kidney transplantation - Advance Access abstract from NDT. - July 4, 2010
WHO probe grapples with differing views on flu pandemic - Article from AFP. - July 2, 2010
Emergence of Gentamicin-Resistant Bacteremia in Hemodialysis Patients Receiving Gentamicin Lock Catheter Prophylaxis - CJASN Express abstract. - July 1, 2010
Antibiotic May Up Risk of Dangerous Potassium Levels in Seniors - Article from HealthDay. - July 1, 2010
Malnutrition-Inflammation Score Independently Determined Cardiovascular and Infection Risk in Peritoneal Dialysis Patients - Issue-in-Progress abstract from Blood Purification. - July 2010
Preventing Infections in Patients Undergoing Hemodialysis - (Registration required, but free.) Article from Medscape Nephrology. - June 29, 2010
Study finds body's potential universal flu defense - Article from Reuters. - June 28, 2010
California says whooping cough is at epidemic levels - Article from the LA Times. - June 24, 2010
The myth of incompatibility of gentamicin and heparin revisited - Abstract from the Journal of Nephrology. - June 23, 2010
Blacks Seem More Vulnerable to Deadly Blood Infection - Article from HealthDay. - June 22, 2010
APP gets FDA approval for version of Cytovene - Article from Bloomsburg. - June 22, 2010
CDC proposes revised guidance for seasonal, H1N1 flu - Article from AHA News. - June 22, 2010
New Method Proposed for Gauging Hospital Infection Rates - Article from HealthDay. - June 22, 2010
CDC Launches “HIV Screening. Standard Care.” to Help Physicians Make HIV Testing a Routine Part of Medical Care - Press release. - June 17, 2010
Study Finds Implications for Reducing Clotting in Kidney Disease Dialysis and Sepsis - Press release from the University of Pennsylvania School of Medicine. - June 16, 2010
Epidemiology, Surveillance, and Prevention of Bloodstream Infections in Hemodialysis Patients - Article in press from AJKD. - June 16, 2010
Brief Communication: Case Reports of Ribavirin Treatment for Chronic Hepatitis E - Abstract from teh Annals of Internal Medicine. - June 14, 2010
Success of Hepatitis C Drugs May Depend on Gene Variant - Article from HealthDay. - June 12, 2010
 
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  HEMODIALYSIS VASCULAR ACCESS INFECTIONS

Guidelines for the Prevention of Intravascular Catheter Related Infections - from Morbidity and Mortality Weekly Report web site - August 2002
Guideline for Prevention of Intravascular Device-related Infections - from the Centers for Disease Control and Prevention (CDC) - 2002
National Surveillance of Dialysis-Associated Diseases in the United States, 2002 (pdf format requires Adobe Acrobat reader) - from The Centers for Disease Control and Prevention (CDC)
K/DOQI™ Clinical Practice Guidelines for Vascular Access - Table of Contents
infection control AND hemodialysis - Pubmed search  Continually Updated!
infection control AND access AND hemodialysis - Pubmed search  Continually Updated!
 

  PERITONEAL CATHETER INFECTIONS

International Society for Peritoneal Dialysis  Treatment GuidelinesTraining Plans (pdf), and  QA Protocols
Adult Peritoneal Dialysis-related Peritonitis Treatment Recommendations: 2000 Update (pdf format) - from the International Society for Peritoneal Dialysis (ISPD) - (pdf format requires Adobe Acrobat reader)
Consensus Guidelines for the Treatment of Peritonitis in Pediatric Patients Receiving Peritoneal Dialysis - from the International Society for Peritoneal Dialysis (ISPD)
infection control AND peritoneal dialysis - Pubmed search  Continually Updated!
infection control AND catheter AND peritoneal - Pubmed search  Continually Updated!
Peritonitis: Dialysis Associated from Medline Plus/National Library of Medicine
 

  ANTIBIOTIC-RESISTANCE

Antimicrobial Resistance Interagency Task Force 2006 Annual Report - from the Centers for Disease Control and Prevention (CDC) - July 2, 2004
Multi-level Antimicrobial Susceptibility Testing Educational Resources from the CDC Division of Laboratory Systems (DLS)
Antibiotic-Resistant Infections news summary reported by RenalWEB - updated June 22, 2005
Management of Multidrug-Resistant Organisms In Healthcare Settings, 2006 (pdf) release from the Centers for Disease Control and Prevention - 2006
MRSA in Healthcare Settings from the Centers for Disease Control (CDC) - October 6, 2006
Invasive Methicillin-Resistant Staphylococcus aureus Infections Among Dialysis Patients --- United States, 2005 from Morbidity and Mortality Weekly Report - March 9, 2007
Invasive Methicillin-Resistant Staphylococcus aureus Infections in the United States - (pdf) article from the Centers for Disease Control and Prevention - October 16, 2007
Staphylococcus aureus Resistant to Vancomycin --- United States, 2002 - from the CDC Morbidity and Mortality Weekly Report (MMWR) - July 5, 2002
HHS Releases Action Plan to Combat Antimicrobial Resistance - press release from the U.S. Department of Health and Human Services - Click here for full report.
Antimicrobial Resistance - from the CDC Division of Healthcare Quality Improvement (DHQI)
Antibiotic (Drug) Resistance - from the National Institutes of Allergy and Infectious Diseases (NIAID)
Antibiotic Resistant Drug Information - from the FDA Center for Drug Evaluation and Research
Campaign to Prevent Antimicrobial Resistance - from the CDC Division of Healthcare Quality Improvement (DHQI)
Campaign to Prevent Antimicrobial Resistance - PowerPoint™ slide show from the CDC Division of Healthcare Quality Improvement (DHQI)
Washington state's campaign to fight antibiotic resistance - from the Washington State Health Department
FDA Task Force on Antimicrobial Resistance - from the U.S. Department of Health and Human Services (HHS)
Prevent Antimicrobial Resistance in Healthcare Settings - How to Order Posters, Laminated Cards and other available materials - from the Centers for Disease Control and Prevention (CDC)
VRE (vancomycin-resistant enterococci) and dialysis - Pubmed search   Continually Updated!
MRSA (methicillin-resistant Staphylococcus aureus) and dialysis - Pubmed search   Continually Updated!
 

  NEEDLESTICK PREVENTION

Workbook for Designing, Implementing, and Evaluating a Sharps Injury Prevention Program - from the Centers for Disease Control and Prevention (CDC) - 2004
Sharps Safety and Needlestick Prevention from ECRI - Price. US$195 for members of any of the following ECRI programs: the Health Devices System, the SELECTplus™ Program, or the Healthcare Risk Control (HRC) System. The cost for nonmembers is US$295
Emergency Needlestick Information - from the Centers for Disease Control and Prevention (CDC) - 2008
Updated U.S. Public Health Service Guidelines for the Management of Occupational Exposures to HIV and Recommendations for Postexposure Prophylaxis - (pdf) article from the Morbidity and Mortality Weekly Report
(MMWR) - September 2005
Updated U.S. Public Health Service Guidelines for the Management of Occupational Exposures to HBV, HCV, and HIV and Recommendations for Postexposure Prophylaxis - (pdf) article from the CDC Division of Healthcare Quality Improvement (DHQI) - June 2001
Needlestick Prevention from OSHA
Occupational Exposure to Bloodborne Pathogens: Needlestick and Other Sharps Injuries, Final Rule from OSHA
Bloodborne Pathogens Standard; Extension of the Office of Management and Budget's (OMB) Approval of Information Collection (Paperwork) Requirements from the Occupational Safety & Health Administration (OSHA)
Sharp Safety:Understanding the Federal Needlestick Prevention Law, Part 1 - January 22, 2001 and Understanding the Federal Needlestick Prevention Law, Part 2 - (includes listing of states with their own OSHA plans) - February 8, 2001 from Nurses.com
needlestick injuries - Pubmed search   Continually Updated!
 

  HEPATITIS

Viral Hepatitis web pages from the Centers for Disease Control (CDC) web site

Hepatitis A, B, and C: Learn the Differences (pdf format requires Adobe Acrobat reader) from the Immunization Action Coalition web site
Hepatitis C virus infection in dialysis patients full-text scholary review from Hemodialysis International - July 2007

Guidelines for the Management of Occupational Exposures to Hepatitis B, Hepatitis C, and HIV and Recommendations for Postexposure Prophylaxis. The MMWR report also includes:

  • Appendix A: Practice Recommendations for Health-Care Facilities Implementing the U.S. Public Health Service Guidelines for Management of Occupational Exposures to Bloodborne Pathogens.
  • Appendix B: Management of Occupational Blood Exposures.
  • Appendix C: Basic and Expanded HIV Postexposure Prophylaxis Regime

Viral Hepatitis Recommendations and Guidelines from the Centers for Disease Control and Prevention (CDC):

KDIGO Guideline for Hepatitis C in CKD from Kidney Disease: Improving Global Outcomes (KDIGO) - August 2008
Revision to OSHA's Bloodborne Pathogens Standard and Frequently Asked Questions - April 2001
Chronic Hepatitis C: Current Disease Management from the NIDDK (November 1999)
National Institute of Health Consensus Development Program: Management of Hepatitis C. 2002
Clinical Practice Guidelines for hepatitis (search result) from the  National Guideline Clearinghouse web site
Recommendations for Prevention and Control of Hepatitis C Virus (HCV) Infection and HCV-Related Chronic Disease from the CDC Morbidity and Mortality Weekly Report (MMWR) - Oct. 16, 1998

  WEB RESOURCES

Latest Scientific Journal Articles on Dialysis and Transplant Infections - list compiled by RenalWEB's Journal Watch
AIDS Info from the U.S. Department of Health and Human Services
Biofilms: Microbial Life on Surfaces from the CDC journal Emerging Infectious Diseases
CDC has an extensive list of resources for bioterrorism
Compliance Control from HyGenius: The Importance of Hand-Washing - web page
Flu Season 2006-2007, Information for Healthcare Providers , Patient and Provider Education Materials from the Centers for Disease Control (CDC)
2008 - 2009 Influenza (Flu) Season Resources for Health Care Professionals - (pdf) from Medlearn Matters/CMS
Dialysis, the Flu, and You: 2007 update from Home Dialysis Central web site
Flu (Influenza) Health Topic from the National Institute of Allergy and Infectious Diseases (NIAID)
Good Health Habits for Preventing the Flu from the Centers for Disease Control and Prevention (CDC) - October 6, 2006
Guidance for Industry and FDA Staff - Medical Glove Guidance Manual - guidance from the Center for Devices and Radiological Health (CDRH) - January 22, 2008
Guidance for Industry: Assessing Donor Suitability and Blood and Blood Product Safety in Cases of Known or Suspected West Nile Virus Infection from the FDA Center for Biologics Evaluation and Research (CBER)
Hand Hygiene in Healthcare Settings from the Centers for Disease Control (CDC)
Hand Hygiene Resource Center web site
Healthcare-Associated Infections (HAIs) from the Centers for Disease Control (CDC)
Infectious Diseases Guidelines 2: What is new and how to use? video from the American Society of Transplantation - April 5, 2010
Infection Control Requirements for Dialysis Facilities and Clarification Regarding Guidance on Parenteral Medication Vials - from the CDC's Morbidity and Mortality Weekly Report via JAMA - November 5, 2008
Immunization Registry Clearinghouse from the Centers for Disease Control (CDC)
List of Safety-Engineered Sharp Devices from the University of Virginia Health System web site
Mycobacterium abscessus: Frequently Asked Questions from the Centers for Disease Control (CDC)

OSHA web site information on bloodborne pathogens

Pandemic Flu

Protect Yourself Poster - poster on bloodborne exposures to pathogens from the CDC web site - January 2008
2008 Quick Reference Chart on Immunization for Providers - (pdf) from the Centers for Medicare & Medicaid Services web site
Severe Acute Respiratory Syndrome (SARS) from the World Health Organization (WHO)

Tuberculosis from the OSHA web site

Use of Anthrax Vaccine in Response to Terrorism: Supplemental Recommendations of the Advisory Committee on Immunization Practices from the CDC Morbidity and Mortality Weekly Report (MMWR) - November 15, 2002
West Nile Virus (WNV) Infection: Information for Clinicians and West Nile Virus Basics from the Centers for Disease Control (CDC)
Association for Professionals in Infection Control and Epidemiology, Inc. (APIC) web site
Infection Control Today web site
Infectious Diseases Society of America (IDSA) web site
The International Health Care Worker Safety Center's Exposure Prevention Information Network (EPINet) web site
International Society for Peritoneal Dialysis (ISPD) web site
National Institute of Allergy and Infectious Diseases (NIAID) web site
U.S. Joint Commission on Accreditation of Healthcare Organizations (JCAHO) web site
U.S. National Institute for Occupational Safety and Health/Centers for Disease Control and Prevention (NIOSH/CDC) web site
 
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  ESSENTIALS AND CLASSICS

Influenza information and guidelines from the CDC
General Infection Control Recommendations for the dialysis center from the CDC Hospital Infections Program.
Bloodborne Infectious Diseases HIV/AIDS, Hepatitis B Virus, and Hepatitis C Virus - information from the National Institutue for Occupational Safetyand Health - March 2008 
Guidelines for Vaccinating Kidney Dialysis Patients and Patients with Chronic Kidney Disease (pdf) from the Centers for Disease Control and Prevention (CDC) - June 2006
Hemodialysis Transducer Protectors - reported by RenalWEB
Sterilants and High Level Disinfectants Cleared by FDA in a 510(k) with General Claims for Processing Reusable Medical Devices from the FDA's Medical Devices - March 2009
Occupational Safety and Health Administration (OSHA) Regulations for Bloodborne Pathogens (1910.1030). Here is a list of fact sheets.
 
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  CLINICAL GUIDELINES AND RECOMMENDATIONS

Compendium of strategies to prevent and treat staph and C difficile infections, ventilator-associated pneumonia, bloodstream infections caused by central-line catheters, and urinary tract and surgical site infections - from Infection Control & Hospital Epidemiology - October 8, 2008
Infection Control Requirements for Dialysis Facilities and Clarification Regarding Guidance on Parenteral Medication Vials - from MMWR/Centers for Disease Control and Prevention (CDC) - August 15, 2008
Infection Control Guidance for the Prevention and Control of Influenza in Acute-Care Facilities - from the Centers for Disease Control and Prevention (CDC) - November 2005
Recommendations for Using Antiviral Agents for Influenza - from the Centers for Disease Control and Prevention (CDC) - April 2006
Guidelines for Preventing Health-Care-Associated Pneumonia, 2003 - from the Centers for Disease Control and Prevention (CDC) - 2004
Adult Peritoneal Dialysis-related Peritonitis Treatment Recommendations: 2000 Update (pdf format) - from the International Society for Peritoneal Dialysis (ISPD) - July 2000 (pdf format requires Adobe Acrobat reader)
Consensus Guidelines for the Treatment of Peritonitis in Pediatric Patients Receiving Peritoneal Dialysis - from the International Society for Peritoneal Dialysis (ISPD) - 2000
Guideline for Environmental Infection Control in Health-Care Facilities, 2003 - from the Centers for Disease Control and Prevention (CDC) - summary from RenalWEB
Guideline for Hand Hygiene in Healthcare Settings - 2002 - from the Centers for Disease Control and Prevention (CDC)
Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings 2007 - from the Centers for Disease Control and Prevention (CDC) - June 2007
Guideline for Prevention of Intravascular Device-related Infections - from the Centers for Disease Control and Prevention (CDC) - 2002
Guidelines for the Management of Intravascular Catheter Related Infections - from the Morbidity and Mortality Weekly Report (MMWR) - August 2002
Guidelines & Recommendations Prevention of Healthcare-Associated Infections - from the CDC
Guidance on Antiviral Drug Use during an Influenza Pandemic - information from Flu.gov web site - December 2008
Issues in Healthcare Settings: Infectious diseases - from the CDC Division of Healthcare Quality Improvement (DHQI)
Materials to Promote Hand Hygiene in your Healthcare Facility - from the Centers for Disease Control and Prevention (CDC)
National Surveillance of Dialysis-Associated Diseases in the United States, 2002 (pdf format requires Adobe Acrobat reader) - from The Centers for Disease Control and Prevention (CDC)
Recommendations for Preventing Transmission of Infections Among Chronic Hemodialysis Patients - April 2001; from the CDC Morbidity and Mortality Weekly Report (MMWR).  
Revised Preventive Measures to Reduce the Possible Risk of Transmission of Creutzfeldt-Jakob Disease (CJD) and Variant Creutzfeldt-Jakob Disease (vCJD) by Blood and Blood Products - guidance document from U.S. Department of Health and Human Services Food and Drug Administration (FDA) on "Mad Cow Disease"
Targeted Tuberculin Testing and Treatment of Latent Tuberculosis Infection - June 2000 - from the CDC Morbidity and Mortality Weekly Report (MMWR).
Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings, 2005 - from the Centers for Disease Control and Prevention (CDC) - December 2005
12 Steps to Prevent Antimicrobial Resistance Among Hospitalized Adults from the Centers for Disease Control and Prevention (CDC). Here is the Powerpoint slide show Version.
Guideline for Disinfection and Sterilization in Healthcare Facilities - (pdf) from the Centers for Disease Control and Prevention (CDC) - 2008
U.S. Public Health Service Guidelines for the Management of Occupational Exposures to HBV, HCV, and HIV and Recommendations for Postexposure Prophylaxis (Click here for the pdf format version) - from the Centers for Disease Control and Prevention (CDC) - 2001
Updated U.S. Public Health Service Guidelines for the Management of Occupational Exposures to HIV and Recommendations for Postexposure Prophylaxis - from the Morbidity and Mortality Weekly Report (MMWR) - 2005
Vaccine recommendations for patients on chronic dialysis - The Advisory Committee on Immunization Practices and the American Academy of Pediatrics - abstract from Seminars in Dialysis - March 2000
Vaccine recommendations and/or guidelines from the Center for Disease Control (CDC)
  * Influenza Vaccination 2007-08 Season - from the Centers for Disease Control and Prevention (CDC)
  * Prevention and Control of Influenza: Recommendations of the Advisory Committee on Immunization Practices (ACIP), 2008 - July 17, 2008
  * Prevention and Control of Meningococcal Disease: Recommendations of the Advisory Committee on Immunization Practices (ACIP) - May 2005
  * Recommended Adult Immunization Schedule for the United States (pdf format requires Adobe Acrobat reader) - October 2006 - Septmenber 2007
  * Use of Anthrax Vaccine in Response to Terrorism: Supplemental Recommendations of the Advisory Committee on Immunization Practices - November 15, 2002
  * Influenza Vaccination of Health-Care Personnel - Recommendations of the Advisory Committee on Immunization Practices (ACIP) - February 2006
  * Use of Standing Orders Programs to Increase Adult Vaccination Rates - Recommendations of the Advisory Committee on Immunization Practices (ACIP) - March 2000
 
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  DISCUSSION FORUM

Vascular Access Issues on RenalWEB
General Nursing Discussion Forum - RenalWEB Discussion Forum
 
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  STATISTICS

National Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992 through June 2004, issued October 2004 (pdf format requires Adobe Acrobat reader) - from The Centers for Disease Control and Prevention (CDC)
Hepatitis C Virus (HCV) infection is the most common chronic bloodborne infection in the United States. Approximately 3.9 million (1.8%) persons in the United States are infected with HCV. About 7% of these may have acquired their infection from blood transfusion. Source: CDC Fact Sheet on Hepatitis C.
After needle stick or sharps exposure to HCV positive blood, about 2 (1.8%) healthcare workers out of 100 will get infected with HCV (range 0%-10%) - from The Centers for Disease Control and Prevention (CDC)
 
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  UPCOMING EVENTS

National Institute of Allergy and Infectious Diseases (NIAID) Selected Events - NIAID web site
FDA/Center for Drug Evaluation and Research (CDER) Sponsored Workshops and Meetings and Presentations
Centers for Disease Control and Prevention Conferences and Events
 
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  RELATED TOPICS

Guidelines & Recommendations for Immunizations - infection control practices from the Centers for Disease Control and Prevention (CDC)
AIDS (auto immune deficiency syndrome) and dialysis - PubMed search - Continually Updated!
hepatitis AND dialysis - PubMed search - Continually Updated!
hepatitis B - PubMed search - Continually Updated!
hepatitis C - PubMed search - Continually Updated!
hepatitis AND vaccine - PubMed search - Continually Updated!
 
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  INPUT / SUGGESTIONS

E-mail to RenalWEB on the Hepatitis Topic
 
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Except where noted, no information within the RenalWEB web site can be copied, duplicated, or reproduced in any form without the express written consent of RenalWEB.