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Preventing access related infection in hemodialysis patients

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Table of Contents
Abstract ........................................................................................................................................... 3
Literature Review............................................................................................................................ 4
Introduction ................................................................................................................................. 4
Methodology ............................................................................................................................... 5
Epidemiology and risk factors..................................................................................................... 6
Prevention Strategies ................................................................................................................... 7
"Fistula First/Catheter Last" Campaign ................................................................................... 8
CDC Guidelines for Catheter Care .......................................................................................... 9
Technological and procedural innovations ................................................................................. 9
Nursing and multidisciplinary approaches ................................................................................ 10
Gaps in Research and Future Directions ................................................................................... 11
Conclusion................................................................................................................................. 12
The project’s implementation actual outcomes ............................................................................ 13
Identification of the issue at the organization ........................................................................... 14
Impact on the Organization ....................................................................................................... 15
Contribution to Nursing Science ............................................................................................... 18
Recommendations for the Future .............................................................................................. 21
Patient education and health literacy ......................................................................................... 23
Conclusion................................................................................................................................. 26
References ..................................................................................................................................... 27

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Preventing access related infection in hemodialysis patients
Abstract
This paper investigates various ways of preventing invasive infections in hemodialysis patients,
focusing on the high morbidity and mortality cases that are prevalent in this group. A thorough
literature review and methodology are utilized. The study emphasizes the importance of
universal precautions as well as technological innovations, nursing, and multidisciplinary
approaches to improve patient care. The evaluation provides current knowledge on
epidemiology, risk factors, prevention strategies, and possible research gaps, suggesting future
programs aimed at decreasing the number of infections. The paper recommends an integrative
approach to improving the safety and efficiency of hemodialysis treatment by promoting
evidence-based practice as well as interdisciplinary collaboration in order to decrease the
morbidity risk and enhance the quality of patient care.

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Literature Review
Introduction

Hemodialysis is a lifelong treatment for patients who have reached end-level renal failure
by providing the capacity to mimic the functions of the kidneys, which are among the most
important organs in the human body, and enabling the removal of extra fluids and waste products
from the blood. This essential therapy is associated with some high risks, which mainly include
infections at vascular access sites (Jukema et al., 2019). Alternatively, infections associated with
access are the leading cause of morbidity and mortality among dialysis patients, followed just by
cardiovascular diseases in terms of their impact (Auguste & Chan, 2022).
Studies have shown that about half of the hemodialysis population suffers from some
kind of disease or condition at the onset of treatment, with pneumonia being the most frequent
illness among dialysis patients. The study indicated that 2 in 10 post-surgery patients have
systemic infections, and the main cause behind the infections was Klebsiella pneumoniae (Al
Himali et al., 2023). The risk is higher mainly because the clinical cases that are present are
usually multidrug-resistant, and therefore they turn out to be very difficult for effective treatment
(Al Himali et al., 2023). This review is composed to gather the present knowledge, look out for
anti-strategies, and recognize the gaps for research to develop a holistic view of our situation and
discover more areas to be studied. The literature discusses an array of components, such as
epidemiology, risk factors, prevention measures, innovations in technology and procedures, and
nursing and multi-disciplinary competencies (Lok, et al., 2019). Therefore, this paper aims to
inform clinical practice and policy that should be enhanced to improve the security and efficacy

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of hemodialysis treatment, which leads to better patients’ outcomes and a decreasing morbidity
risk.

Methodology

A comprehensive search was carried out to build a strong foundation for the allencompassing literature review, which went across several scientific databases such as PubMed,
Scopus, and CINAHL. The search strategy was profoundly developed and included studies about
access-related infections among hemodialysis patients (Buetti et al., 2022). This included a wide
spectrum of other similar studies combining MeSH terms and free text phrases, aiming to capture
all the relevant and appropriate studies on this issue. Key words like "hemodialysis," "accessrelated infections," "and hospital-acquired infections," "vascular access infection
prevention," "antimicrobial strategies," and "infection control in hemodialysis" were utilized.
In line with the rigorous criteria set to include quality articles and exclude irrelevant
pieces, this review only covered research papers of high quality. We utilized inclusion criteria,
which included peer-reviewed articles published within the last ten years, articles written in
English, and studies dealing directly with access-related infections in hemodialysis patients
(Crabtree et al., 2019). Directly empirical research, such as randomized controlled trials and
observational studies, was looked at, as was reviewing articles that covered the topic from
different perspectives, which were considered to provide a holistic and comprehensive analysis
(Irum, 2023). Narrowing the search began with an assessment of titles and abstracts for inclusion
criteria in the topic of preventing infection attributable to access among hemodialysis patients.
This was followed by retrieving full texts and potentially relevant articles after a further
screening of the titles, which were then subjected to assessment on the level to which they had

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contributed to the knowledge surrounding the topic (Ishigami & Matsushita, 2019). This
systematic selection of articles enabled the selection of the most relevant topics under the scope
of this literature review.

Epidemiology and risk factors

The epidemiology of this infection is complex, being contributed by many different
factors in real time, increasing its susceptibility to this population. Studies have constantly
reported high incidence rates of these infections being rampant in hospitals, hence increasing
morbidity rates, hospitalizations, and mortality among patients. Al Himali et al. (2023) specify
that 30% of the hemodialysis patients have healthcare-associated infections, including
pneumonia, identified with Klebsiella pneumoniae as a major pathogen. This implies the fact that
targeted infection prevention measures are crucial for hemofiltration.
Besides pathogens as risk factors, access-related infections can also arise because of the technical
and patient-specific elements involved. Auguste and Chan (2022) focus on the risk factors
associated with these infusions, including the kind of vascular access (e.g., central venous
catheters, AV fistulas, and grafts), cannulation methods, and patients' immunological status. It is
essential to mention that the type of vascular access as well plays a role with central venous
catheter (CVC) being more likely to get infected compared to arteriovenous fistula (AVF) and
arteriovenous graft (AVG) (El-Ballat, El-Sayed & Emam, 2019). This can be exemplified under
the “Fistula First/Catheter Last” approach, which recommends the priority between AVFs and
AVGs over CVCs in terms of infections prevention.
According to Fisher et al. (2023), these kinds of patients are normally found to have an
elevated rate of infectious morbidities which are mostly caused by the vascular access

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infections. The main reason for hospitalizations and deaths among this group of patients is
infections. The research (conducted in this study) thus focuses on the varying infection risks
based on the different types of vascular access, where the CVC is the one most at risk. Besides
that, the work provides useful pointers on the CDC's CVC key performance measures for
hemodialysis CVC care to lower the possibility of leading to sepsis or CVC-associated BSI
infections, stressing the fact that adherence to the set standards is necessary. As Fisher et al.
(2020) point out, the risk of bloodstream infections caused by hemodialysis catheters remains
stable, irrespective of the progress of preventive strategies that have been developed. The study
addresses the need for strict adherence to aseptic principles as well as investigating innovative
preventive strategies to try and bring down catheter-related infections in the US, which is
unacceptable news. For instance, Gorke et al. (2019) reveals that establishing a comprehensive
surveillance and preventive strategy in two hemodialysis units helped reduce the mortality rates
caused by access-related infections. Hasanoglu et al. (2020) support the same argument in their
study’s findings. However, this intervention, which includes, among others, an assessment of the
operating environment, the following of rules, and the use of specialized tools for vascular access
management, gives an impression of the possibility of focused strategies to reduce infection risks
in a big way.

Prevention Strategies

Preventing access-related infections in the patients of the hemodialysis sessions requires
a thorough, multifaceted approach comprising the implementation of effective guidelines in
conjunction with evidence-based practices combined with the holding of the best practices in
vascular access management. To prevent HAP (hospital-acquired pneumonia), there are two (2)

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essential strategies: "fistula first, catheter last" and adherence to CDC (Centers for Disease
Control and Prevention) guidelines for catheter care (Kumbar & Yee, 2019; Ministry of Health
and family welfare (MOHFW), Government of India, 2020). These solutions are backed by
research and evidence-based data to ensure the success of t...