CDC Promotes Campaign to Prevent Antimicrobial Resistance in Dialysis Patients
The Centers for Disease Control and Prevention (CDC) announced today, during the American Society of Nephrology conference, a campaign aimed at nephrologists to prevent antimicrobial resistance in dialysis patients.
Like the overall campaign to reduce antimicrobial resistance in healthcare settings, launched in March 2002, the component targeting nephrologists centers around four key strategies for preventing antimicrobial resistance in healthcare settings: 1) preventing infection, 2) diagnosing and treating infection effectively, 3) using antimicrobials wisely, and 4) preventing transmission of drug-resistant pathogens. Within these strategies are 12 specific action steps derived from evidenced-based guidelines and recommendations already developed by CDC and other organizations that clinicians can take now to prevent antimicrobial resistance in dialysis patients.
"Due to frequent hospitalizations, receipt of antibiotics, and exposure to bacterial infections at the vascular access site, dialysis patients have an ongoing risk for antimicrobial resistance," said Dr. Steve Solomon, director of CDC's healthcare quality promotion program. This campaign gives nephrologists 12 steps to protect their patients from this ongoing risk."
The action steps for nephrologists who provide care for dialysis patients include:
Action Step 1: Vaccinate Staff and Patients
Get influenza vaccine
Give influenza and pneumococcal vaccine to patients in addition to routine vaccines (e.g. hepatitis B)
Action Step 2: Get the Catheters Out
Use catheters only when essential
Maximize use of fistulas/grafts
Remove catheters when they are no longer essential
Remove/replace infected catheters
Action Step 3: Optimize Access Care
Follow established KDOQI and CDC Guidelines for access care
Use proper insertion and catheter-care protocols
Remove access device when infected
Use the correct catheter
Action Step 4: Target the Pathogen
Obtain appropriate cultures
Target empiric therapy to likely pathogens
Target definitive therapy to known pathogens
Optimize timing, regimen, dose, route, and duration
Action Step 5: Access the Experts
Consult the appropriate expert for complicated infections
Action Step 6: Use Local Data
Know your local antibiogram
Get previous microbiology results when patients transfer to your facility
Action Step 7: Know When to Say "No" to Vanco
Follow CDC guidelines for vancomycin use
Consider 1st generation cephalosporins instead of vancomycin
Action Step 8: Treat Infection, Not Contamination or Colonization
Use proper antisepsis for drawing blood cultures
Get one peripheral vein blood culture, if possible
Avoid culturing vascular catheter tips
Treat bacteremia, not the catheter tip
Action Step 9: Stop Antimicrobial Treatment
When infection is treated
When infection is not diagnosed
Action Step 10: Follow Infection Control Precautions
Use standard infection control precautions for dialysis centers
Consult local infection control experts
Action Step 11: Practice Hand Hygiene
Wash your hands or use an alcohol-based handrub
Set an example
Action Step 12: Partner With Your Patients
Educate on access care and infection control measures
Some of the materials being developed include a slide set featuring the 12 action steps and the evidence to support them, posters, as well as a badge cards listing the 12 action steps. The campaign also features a website where nephrologist may access the 12 action steps as well as information to share with their patients.
Antimicrobial resistant infections in healthcare settings are a major threat to patient safety. Each year in the United States an estimated 2 million hospitalized people acquire infections that result in more 90,000 deaths. More than half of these infections are caused by bacteria that are resistant to at least one of the antimicrobials commonly used to treat those infections, according to CDC.
"CDC believes that this educational campaign can increase patient safety by preventing life-threatening antibiotic resistant infections," said Solomon. "In the future, CDC will announce similar action steps for clinicians who care for surgical patients, patients in long-term care facilities, and hospitalized children."
This campaign is made possible through support from the CDC Foundation http://www.cdcfoundation.org/. For more information on CDC's campaign to prevent antimicrobial resistance in healthcare settings go to www.cdc.gov/drugresistance/healthcare.
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