Practical Strategies for Prevention of Catheter‐Related Bloodstream Infections ( CRBSI ) in United States Hemodialysis Facilities

Hemodialysis (HD) patients are at high risk for infection owing to the necessity of vascular access to the bloodstream for treatments. Despite widespread efforts to promote early establishment of arteriovenous fistula or graft (AVF/G) for HD, 70%-80% of patients initiate dialysis with a central venous catheter (CVC). Catheter-related bloodstream infections (CRBSIs) are a known risk of central venous catheter use, accounting for 70% of HD access-related bloodstream infections. Given the significant morbidity, mortality, and cost associated with central venous catheter use, prevention of CRBSIs is a major priority for nephrologists, dialysis facilities, and kidney care organizations attempting to improve quality and deliver safe care to dialysis patients. Recent strategies for prevention of CRBSI in HD have broadened focus to pre-dialysis education and planning and a growing armamentarium of evidence-based interventions to avoid or mitigate the consequences of central venous catheter use. New commercially available products containing chlorhexidine and taurolidine promise to augment core interventions to prevent CRBSI in dialysis facilities. This manuscript reviews selected topics and recent advances in knowledge related to preventing CRBSI in HD, with emphasis on dialysis care in United States.