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Infection Control in the Dialysis Setting Part 3 of 4
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  1. Infection Control in the Dialysis Setting Part 3 of 4 Danilo B. Concepcion CCHT, CHT Manager, Renal Technology Services Email: danilo.concepcion@stjoe.org Phone: 714.771.8944 The findings and conclusions in this presentation are those of the author and do not necessarily represent the views of St. Joseph Hospital

  2. PROBLEM WITH INFECTION IN DIALYSIS

  3. The Problem of Infection • Second leading cause of death (after CVD) • Vascular access is the leading cause of hospitalization • Bacteremia (ranging from 7000 to 15,000 cases per year) can result in: • Septic shock • endocarditis • Septic arthritis • Osteomyelitis • Epidural abcesses • Exposes patients to multiple antibiotics and at risk for antibiotic resistance Allon (2004)

  4. Epidemiology of Infections Among Hemodialysis Patients • Site of infection • 57% vascular access • 23% wound • 15% lung • 5% urinary tract USRDS 2005 Annual Data Report Tokars, Miller, Stein. AJIC 2002;30:288-295

  5. The Problem of MRSA Infection • Overall incidence of infection is 45.2 cases per 1000 patients – 100 times that of the general population (0.2 – 0.4 per 1000) • MRSA poses the biggest threat to dialysis patients (HD & PD) • 74% of the cases were in dialysis patients > 50 years old • 85% of the dialysis patients had catheters or other invasive devices in place • 90% of dialysis cases were hospitalized • 17% MRSA cases resulted in death

  6. Differences in Event Rates: Fistula vs. Catheter Tokars, Miller, Stein. AJIC 2002;30:288-295 Pastan, Soucie, McClellan. Kidney Int 2002;62:620-626

  7. Rate of Hospitalization by Vascular Access Type Dialysis Surveillance Network 1999-2005

  8. Rate of Vascular Access Infection by Vascular Access Type Dialysis Surveillance Network 1999-2005

  9. Rate of Access-Related Bloodstream Infection by Vascular Access Type Dialysis Surveillance Network 1999-2005

  10. Types of Vascular Access, U.S. Hemodialysis Patients, by Year Finelli, Miller, Tokars. Semin Dial 2005;18:52-61