Heather Weirich, BSN, RN, CNN has been a nurse for 18 years and a dialysis nurse for the past 11 years with the Independent Dialysis Foundation (IDF). Five years ago she began training clinical staff and completing competency assessments as an educator for IDF. “A big part of this education has been infection control,” Ms. Weirich said.
She is also a member of the Centers for Disease Control and Prevention (CDC) Dialysis Bloodstream Infections (BSI) Collaborative. The collaborative consists of the CDC and participating dialysis facilities that worked together to develop and implement BSI prevention strategies. They have produced audit tools, checklists and protocols for infection prevention in dialysis facilities as well as core interventions for BSI prevention that are posted on the CDC website. Ms. Weirich is also a member of the steering committee for the Collaborative.
According to the CDC, dialysis patients are more than 100 times more likely to get a BSI from a common resistant bacteria, methicillin-resistant Staphylococcus aureus, than people who are not on dialysis. Infection is the second leading cause of death for hemodialysis patients, and dialysis patients with catheters are at a higher risk for infection. “The number one goal is to get the catheter out and have a fistula created,” Ms. Weirich said. “In some cases it’s not possible [to have a fistula created] and in others, patients refuse despite education. We have to focus on eliminating catheters [to reduce infections].”
A CDC study, published in 2011, showed a 58 percent reduction in central-line associated BSI after new CDC infection prevention guidelines were implemented. The study recommends reducing catheter use for hemodialysis and improving the maintenance of catheters to prevent BSI.
Ms. Weirich has also participated in the CDC “Scrub the Hub” workgroup. “Scrub the Hub” protocol includes steps for disinfecting the ends of catheters when the patient is connected to or disconnected from hemodialysis. “Scrub the Hub is very different from the method we all learned years ago,” Ms. Weirich said. When she is training staff on infection control, she likes to quote the research behind the change in procedure. “It’s evidence-based practice that makes a difference in the morbidity and mortality of patients with catheters,” she said. “Knowing why [a procedure should change] helps with resistance to change.”
The next step is showing that these changes are sustainable over time. Ms. Weirich is the co-author of a CDC study on sustainability* which will be published in 2016. “The goal is zero infections, always,” she said. “There’s always room for improvement. As long as we can continue to show that we’ve made a difference in patient outcomes, we can celebrate that. But the goal is always there.”
Ask the Experts is a continuing series of profiles and interviews, focusing on topics of interest to professionals in the kidney community.
* Sarah H. Yi, Alexander J. Kallen, Sally Hess, Virginia R. Bren, Mary E. Lincoln, Gemma Downham, Karen Kelley, Stephanie L. Booth, Heather Weirich, Alicia Shugart, Christi Lines, Anna Melville, John A. Jernigan, David G. Kleinbaum, and Priti R. Patel, Sustained infection reduction in outpatient hemodialysis centers participating in a collaborative bloodstream infection prevention effort.