News
ICViewExpert PerspectivesMedical World NewsPathogen PlaybookVideosWebinars
Conference CoverageConference ListingAPIC Chapters
Infection Control TodaySupplements And Featured Publications
CME/CEEditorial Advisory BoardJob BoardPartnersSponsoredWhitepapers
Subscribe
Educator of the Year Official Rules2024 Educator of the Year Winner2023 Educator of the Year WinnerEducator of the Year
Advanced TechnologyAdvanced TechnologyAdvanced Technology
Bug of the Month
COVID-19
Environmental ServicesEnvironmental Services
HAIs
Hand Hygiene
IC Trends
Long-Term CareLong-Term Care
Operating Room
Personal Protective EquipmentPersonal Protective Equipment
Policy
PreventionPreventionPreventionPrevention
Sterile ProcessingSterile Processing
Surface Disinfection
Vascular Access
Spotlight -
  • IC Trends
  • Bug of the Month
  • Featured Articles
  • Featured Columns
  • Pathogen Playbook
Advanced TechnologyAdvanced TechnologyAdvanced Technology
Bug of the Month
COVID-19
Environmental ServicesEnvironmental Services
HAIs
Hand Hygiene
IC Trends
Long-Term CareLong-Term Care
Operating Room
Personal Protective EquipmentPersonal Protective Equipment
Policy
PreventionPreventionPreventionPrevention
Sterile ProcessingSterile Processing
Surface Disinfection
Vascular Access
    • News
    • Subscribe
Advertisement

How to Prevent Risk of Vascular Access-Related Blood Stream Infections in Patients Undergoing Hemodialysis

August 23, 2023
By Shazia Irum, MSC, MBA, RN, CIC, CPHQ
News
Article
Infection Control TodayInfection Control Today, September/October 2023 (Vol. 27 No. 7)
Volume 27
Issue 7

Staphylococcal organisms, which have high mortality rates and can cause recurrence and metastatic complications, are responsible for a significant proportion of infections related to vascular access.

Hemodialysis bloodline tubes in dialysis machine. © zlikovec- stock.adobe.com

Hemodialysis bloodline tubes in dialysis machine. © zlikovec- stock.adobe.com

Vascular access-related infection is a second major cause of mortality among end-stage renal disease patients undergoing hemodialysis (HD). Dialysis patients require vascular access to deliver their renal failure treatment. Commonly used vascular accesses are arteriovenous fistula (AVF), arteriovenous graft (AVG), and central lines.1,2 Vascular access-related infection is highest when central venous dialysis catheters are employed. Native arteriovenous fistulas carry the lowest risk of infection.1 Unfortunately, prosthetic arteriovenous grafts, which represent the most common type of HD access in the United States, have been repeatedly shown to be a risk factor for bacteremic and nonbacteremic infections. High proportions of infections related to vascular access are caused by staphylococcal organisms, which carry high mortality rates, recurrence, and metastatic complications.1,2

Several studies have attempted to define catheter-related bacteremia (CRB) risk factors.1 Both the insertion site and the use duration influence the infection rate. Femoral catheters are more susceptible to infections than thoracic catheters. This may relate to the accumulation of sweat and moisture around the exit site. The type of catheter and site of insertion significantly impact the involvement of catheter-related infections, such as tunneled and cuffed catheters, are considered as a low incidence of bacteremia compared to non-tunneled catheters.2 Similarly, temporary HD catheters placed in the internal jugular vein are associated with higher infection rates than those placed in the subclavian vein.2

However, these outcomes should not justify the routine use of subclavian veins for HD catheters for 2 reasons. First, these findings may not apply to tunneled catheters. Second, the subclavian location carries the highest rate of catheter-associated central venous stenosis. The duration of catheter use is also essential as the risk of infection increases linearly with time.2,3

Nurses, medical providers, dialysis technicians, and others who work in dialysis facilities face the difficult task of managing the complex circumstances affecting their patients while concurrently focusing on reducing the risk of infection for these at-risk individuals. CDC’s core interventions have been proven to reduce dialysis bloodstream infections and can help to improve the quality of vascular access in dialysis patients.4

Staff Education and Training
Educating health care providers regarding the appropriate need and use of intravascular catheters and the proper insertion techniques can significantly reduce the risk of vascular infections in dialysis patients. Periodic competency assessment and appropriate staffing ratio is another supportive intervention in preventing infections.

Selection of Vascular Access
The use of fistula and graft in chronic kidney disease patients for their dialysis treatment is highly recommended.1,2,4 Subclavian sites in dialysis and chronic kidney disease patients should be avoided as much as possible to prevent the long-term complication of central venous stenosis. Avoiding using femoral sites for central line insertion in adult patients also significantly reduces bloodstream infections.

Use of Aseptic Technique
Performing hand hygiene procedures and following strict aseptic measures are core considerations in preventing vascular access-related infections. Wearing either clean or sterile gloves when changing dressings on central lines is acceptable; however, to ensure maximal barrier precautions, cap, sterile gloves, sterile gown, and sterile full body drape are highly recommended during the insertion of central lines.

Antibiotic Lock Prophylaxis
Using prophylactic antimicrobial lock solution in patients with long-term catheters who have a history of multiple catheter-related bloodstream infections (CRBSI) despite optimal maximal adherence to aseptic technique is a recognized approach to reduce the incidence of BSI among dialysis patients.4,5

Patient Education and Engagement
Provision of standardized education to all patients on infection prevention topics, including vascular access care, hand hygiene, risks related to catheter use, recognizing signs of infection, and instructions for access management when away from the dialysis unit is one of the highly impactful preventive measures. Patients with fistulas should be instructed to wash their access site with soap and water before cannulation during each dialysis session. Patients dialyzed through central lines need to be instructed not to change their dressings at home. Also, they should avoid merging the catheter insertion sites in water. Prompt reporting of local site infections around vascular access, such as pus, increased swelling, and redness, is required.

Catheter Skin Preparation
According to CDC, >0.5% chlorhexidine preparation with alcohol before central venous catheter insertion and during maintenance care is advisable. If there is a contraindication to chlorhexidine, a tincture of iodine, an iodophor, or 70% alcohol can be used as alternatives.4

Reduction
One of the highly effective core interventions is to reduce the number of central lines in dialysis patients. Early initiation of fistulas is highly recommended during stages 4 and 5 of end-stage renal disease. Incorporate efforts (eg through patient education, vascular access coordinator) to reduce catheters by identifying and addressing barriers to permanent vascular access placement and catheter removal.6,7,8,9

Surveillance and Feedback Using NHSN
Conducting monthly surveillance for BSIs and other dialysis events using the National Healthcare Safety Network (NHSN)—Dialysis Surveillance.6 Calculating facility rates and comparing them with other NHSN facilities. Actively sharing results with front-line clinical staff is a highly effective strategy to ensure maximum staff compliance to reduce vascular access infections in dialysis patients. Another source is CDC audit tools and checklists for BSI prevention in dialysis patients.4

References
1. Gulati S, Sahu KM, Avula S, Sharma RK, Ayyagiri A, Pandey CM. Role of vascular access as a risk factor for infections in hemodialysis. Ren Fail. 2003;25(6):967-973. doi:10.1081/JDI-120026031
2. Nassar GM, Ayus JC. Infectious complications of hemodialysis access. Kidney Int. 2001;60(1):1-13. doi:10.1046/j.1523-1755.2001.00765.x
3. Kairaitis LK, Gottlieb T. Outcome and complications of temporary haemodialysis catheters. Nephrol Dial Transplant. 1999;14(7):1710-1714. doi:10.1093/ndt/14.7.1710
4. Dialysis component. Centers for Disease Control and Prevention. March 30, 2023. Accessed August 22, 2023.
5. Summary of recommendations. Centers for Disease Control and Prevention. February 2017. Accessed August 22, 2023. https://www.cdc.gov/infectioncontrol/guidelines/bsi/recommendations.html
6. Audit Tools and Checklists. Centers for Disease Control and Prevention. January 11, 2023. Accessed August 22, 2023.
7. Shahar S, Mustafar R, Kamaruzaman L, Periyasamy P, Pau KB, Ramli R. Catheter-related bloodstream infections and catheter colonization among haemodialysis patients: prevalence, risk factors, and outcomes. Int J Nephrol. 2021:5562690. doi:10.1155/2021/5562690
8. Kumbar L, Yee J. Current concepts in hemodialysis vascular access infections. Adv Chronic Kidney Dis. 2019;26(1):16-22. doi:10.1053/j.ackd.2018.10.005
9. Health Services Advisory Group. Reducing dialysis related infections and hospitalizations. Susan Moretti. End-stage renal disease network 15. September 19, 2018. Accessed August 22, 2023. https://health.wyo.gov/wp-content/uploads/2018/09/Moretti-ReduceDialysisRelatedInfHos508.pdf






Download Issue PDF
Articles in this issue

ICT's Product Locator column
ICT's Product Locator: September/October 2023
Bug of the Month (Adobe Stock 57303652 by Dr_Microbe)
Bug of the Month: I Make Tummies Hurt
Photo of doctor's hands holding legs of a newborn in an incubator in a  neonatal intensive care unit.  (Adobe Stock, 464090504 by Iryna)
Infection Prevention in the NICU: A Changing Landscape
Health care workers taking care of patient with ventilator    (AdobeStock 620931560 by JoshuAA/peopleimages.com)
Ventilation and the Risk of Health 
Care–Associated Infections
An infection preventionist taking off her mask. (Adobe Stock, unknown)
I’m Not Just an Infection Preventionist
Influenza, RSV, and COVID-19 (AdobeStock_249346161, AdobeStock_538653843,AdobeStock_471755796)
How to Prepare For Possible “Tripledemic” of RSV, Influenza, and SARS-CoV-2
Association for the Health Care Environment (Logo used with permission)
Environmental Spread of Emerging Pathogens: AHE Conference Discussion
Plague doctor, a physician who treated bubonic plague.  (Adobe Stock FILE #: 559266031 by Worldillustrator)
Protecting HCWs: Plague Doctor's Masks to the Personal Protective Equipment of Tomorrow
AHE: Association for the Health Care Environment  (Photo used with permission by AHE)
AHE Exchange Conference & Solution Center 2023 Review
Woman lying in hospital bed (Adobe Stock, unknown)
What Are Patients’ Fears Around Hospitalization? A Survey Found Out
Hebah Al Zamel, BSN, MSN, CPHQ, CIC, a policy consultant and infection control practitioner at King Abdullah University Hospital, discusses the importance of patient safety with Infection Control Today.   (Photo courtesy of Hebah Al Zamel, BSN, MSN, CPHQ, CIC)
Creating the Framework of Patient Safety
How to Prevent Risk of Vascular Access-Related Blood Stream Infections in Patients Undergoing Hemodialysis
How to Prevent Risk of Vascular Access-Related Blood Stream Infections in Patients Undergoing Hemodialysis
White Coats: Potential Carriers of Bacteria
White Coats: Potential Carriers of Bacteria
Photo of a model operating room. (Photo courtesy of Indigo-Clean and Kenall Manufacturing)
Visible-Light Continuous Environmental Disinfection System Reduces Pathogens
Washington, USA, US Treasury Department and Inspector General Office.    (Adobe Stock File 210945332 by Brian_Kinney)
OIG's Adverse Events Toolkits: Preventing Patient Harm

Newsletter

Stay prepared and protected with Infection Control Today's newsletter, delivering essential updates, best practices, and expert insights for infection preventionists.

Subscribe Now!
Recent Videos
DJ Shannon, MPH, CIC, VA-BC, FAPIC
Jordan Bastian, MPH, CIC, at APIC25
Jordan Bastian, MPH, CIC, at APIC25
Rebecca Battjes, MPH, CIC, FAPIC; Vidya Nankoosingh, MLT, CIC; and Peter Teska, MBA
Mark Wiencek, PhD
Rebecca Crapanzano-Sigafoos, DrPH, CIC, AL-CIP, FAPIC
The CDC’s updated hospital respiratory reporting requirement has added new layers of responsibility for infection preventionists. Karen Jones, MPH, RN, CIC, FAPIC, clinical program manager at Wolters Kluwer, breaks down what it means and how IPs can adapt.
Studying for the CIC using a digital tablet and computer (Adobe Stock 335828989 by NIKCOA)
Infection Control Today's Conversations with the HSPA President, Arlene Bush, CRCST, CER, CIS, SME, DSMD, CRMST
Infection Control Today's Conversations with the HSPA President, Arlene Bush, CRCST, CER, CIS, SME, DSMD, CRMST
Related Content

Set of bright yellow sharps containers with biohazard labels and red lids used in clinics and hospitals for safe disposal of medical needles and waste. (Adobe Stock 1521632893 by Maksim)

Reducing Hidden Risks: Why Sharps Injuries Still Go Unreported

Tori Whitacre Martonicz
July 18th 2025
Article

Despite being a well-known occupational hazard, sharps injuries continue to occur in health care facilities and are often underreported, underestimated, and inadequately addressed. A recent interview with sharps safety advocate Amanda Heitman, BSN, RN, CNOR, a perioperative educational consultant, reveals why change is overdue and what new tools and guidance can help.


Realistic electron microscopy of Clostridioides difficile, highly detailed rod-shaped structure, spores with textured surfaces, flagella, acid-green and purple hues, contrasting black background.  (Adobe Stock 1318793046 by Waseem by AI)

New Study Explores Oral Vancomycin to Prevent C difficile Recurrence, But Questions Remain

Tori Whitacre Martonicz
July 17th 2025
Article

A new clinical trial explores the use of low-dose oral vancomycin to prevent Clostridioides difficile recurrence in high-risk patients taking antibiotics. While the data suggest a possible benefit, the findings stop short of statistical significance and raise red flags about vancomycin-resistant Enterococcus (VRE), underscoring the delicate balance between prevention and antimicrobial stewardship.


What Lies Beneath: Why Borescopes Are Essential for Verifying Surgical Instrument Cleanliness

What Lies Beneath: Why Borescopes Are Essential for Verifying Surgical Instrument Cleanliness

Tori Whitacre Martonicz
July 16th 2025
Article

Despite their smooth, polished exteriors, surgical instruments often harbor dangerous contaminants deep inside their lumens. At the HSPA25 and APIC25 conferences, Cori L. Ofstead, MSPH, and her colleagues revealed why borescopes are an indispensable tool for sterile processing teams, offering the only reliable way to verify internal cleanliness and improve sterile processing effectiveness to prevent patient harm.


Operating room, surgical site infections   (Adobe Stock, Unknown)

The Next Frontier in Infection Control: AI-Driven Operating Rooms

Tori Whitacre Martonicz
Published: July 15th 2025 | Updated: July 15th 2025
Article

Discover how AI-powered sensors, smart surveillance, and advanced analytics are revolutionizing infection prevention in the OR. Herman DeBoard, PhD, discusses how these technologies safeguard sterile fields, reduce SSIs, and help hospitals balance operational efficiency with patient safety.


The doctor is injecting a vaccination into the arm of a little girl.   Adobe Stock 170524806 by pingpao

Targeting Uncertainty: Why Pregnancy May Be the Best Time to Build Vaccine Confidence

Tori Whitacre Martonicz
July 15th 2025
Article

New national survey data reveal high uncertainty among pregnant individuals—especially first-time parents—about vaccinating their future children, underscoring the value of proactive engagement to strengthen infection prevention.


The doctor is injecting a vaccination into the arm of a little girl.   Adobe Stock 170524806 by pingpao

No Link Found Between Aluminum in Vaccines and Chronic Disorders

Tori Whitacre Martonicz
July 14th 2025
Article

A Danish study of 1.2 million children found no increased risk of autoimmune, allergic, or neurodevelopmental disorders from aluminum in early childhood vaccines, helping close key safety evidence gaps.

Related Content

Set of bright yellow sharps containers with biohazard labels and red lids used in clinics and hospitals for safe disposal of medical needles and waste. (Adobe Stock 1521632893 by Maksim)

Reducing Hidden Risks: Why Sharps Injuries Still Go Unreported

Tori Whitacre Martonicz
July 18th 2025
Article

Despite being a well-known occupational hazard, sharps injuries continue to occur in health care facilities and are often underreported, underestimated, and inadequately addressed. A recent interview with sharps safety advocate Amanda Heitman, BSN, RN, CNOR, a perioperative educational consultant, reveals why change is overdue and what new tools and guidance can help.


Realistic electron microscopy of Clostridioides difficile, highly detailed rod-shaped structure, spores with textured surfaces, flagella, acid-green and purple hues, contrasting black background.  (Adobe Stock 1318793046 by Waseem by AI)

New Study Explores Oral Vancomycin to Prevent C difficile Recurrence, But Questions Remain

Tori Whitacre Martonicz
July 17th 2025
Article

A new clinical trial explores the use of low-dose oral vancomycin to prevent Clostridioides difficile recurrence in high-risk patients taking antibiotics. While the data suggest a possible benefit, the findings stop short of statistical significance and raise red flags about vancomycin-resistant Enterococcus (VRE), underscoring the delicate balance between prevention and antimicrobial stewardship.


What Lies Beneath: Why Borescopes Are Essential for Verifying Surgical Instrument Cleanliness

What Lies Beneath: Why Borescopes Are Essential for Verifying Surgical Instrument Cleanliness

Tori Whitacre Martonicz
July 16th 2025
Article

Despite their smooth, polished exteriors, surgical instruments often harbor dangerous contaminants deep inside their lumens. At the HSPA25 and APIC25 conferences, Cori L. Ofstead, MSPH, and her colleagues revealed why borescopes are an indispensable tool for sterile processing teams, offering the only reliable way to verify internal cleanliness and improve sterile processing effectiveness to prevent patient harm.


Operating room, surgical site infections   (Adobe Stock, Unknown)

The Next Frontier in Infection Control: AI-Driven Operating Rooms

Tori Whitacre Martonicz
Published: July 15th 2025 | Updated: July 15th 2025
Article

Discover how AI-powered sensors, smart surveillance, and advanced analytics are revolutionizing infection prevention in the OR. Herman DeBoard, PhD, discusses how these technologies safeguard sterile fields, reduce SSIs, and help hospitals balance operational efficiency with patient safety.


The doctor is injecting a vaccination into the arm of a little girl.   Adobe Stock 170524806 by pingpao

Targeting Uncertainty: Why Pregnancy May Be the Best Time to Build Vaccine Confidence

Tori Whitacre Martonicz
July 15th 2025
Article

New national survey data reveal high uncertainty among pregnant individuals—especially first-time parents—about vaccinating their future children, underscoring the value of proactive engagement to strengthen infection prevention.


The doctor is injecting a vaccination into the arm of a little girl.   Adobe Stock 170524806 by pingpao

No Link Found Between Aluminum in Vaccines and Chronic Disorders

Tori Whitacre Martonicz
July 14th 2025
Article

A Danish study of 1.2 million children found no increased risk of autoimmune, allergic, or neurodevelopmental disorders from aluminum in early childhood vaccines, helping close key safety evidence gaps.

Advertise
About Us
Editorial Board
Contact Us
Job Board
Terms and Conditions
Privacy
Do Not Sell My Personal Information
Contact Info

2 Commerce Drive
Cranbury, NJ 08512

609-716-7777

© 2025 MJH Life Sciences

All rights reserved.
Home
About Us
News