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Despite overall drop, infection rate remains high for dialysis patients

The Centers for Disease Control and Prevention reported a drastic drop in one type of patient infection in hospitals, noting that targeted efforts have saved lives and millions of dollars. Yet the report also reveals that the same type of infections are showing up in large numbers at dialysis facilities, which now report more cases than hospital intensive-care units.

The report focuses on “central line” infections, which patients get when sanitary practices aren’t followed in the handling of tubes that deliver medications directly into a patient’s vein.

The number of such infections in hospital intensive care units fell sharply, from 43,000 in 2001 to 18,000 in 2009, based on estimates by the Center for Disease Control. The estimates from 2001 are based on data reported voluntarily by 289 hospitals, a spokeswoman said.

Now, more than half of the states are required to report such infections, and 2009 data is based on reports from 1,540 facilities, a spokeswoman for the center said. Those states include California, which has issued its own report [PDF] on that type of infection.

The Center for Disease Control does not estimate how many infections were related to dialysis facilities in 2001. But its best guess for infections in 2008 put dialysis facilities at nearly the same starting point as ICUs in 2001, with an estimated 37,000 infections related to outpatient kidney-cleaning treatments.

The report and Consumers Union, which advocates for patient safety, credit targeted infection-control efforts in hospitals with bringing down the infection numbers by 58 percent.

Such efforts are not in place for dialysis patients, said Roberta Mikles, a retired nurse and member of the California Department of Public Health advisory committee on health care-associated infections [PDF]. She said the facilities do not tend to report to a key Center for Disease Control database tracking central line infections.

The center's report found that dialysis patients are 100 times more likely to get an antibiotic-resistant staph infection than other people.

None of this came as a surprise to Mikles, who runs a website advocating for dialysis patients.

“As far as I’m concerned as a patient advocate, there’s no excuse for this to continue in dialysis facilities,” Mikles said.

Mikles uses her website to publicize inspections of dialysis facilities that are done by state public health and Medicare authorities. She said 23 out of 25 facilities inspected in the first part of this year were cited for infection control shortcomings, some of which are detailed here.

The nonprofit investigative news organization ProPublica fought and won access to once-confidential data on infections related to dialysis facilities. (This data is unrelated to the center's report.)

The data includes facility-by-facility rates of infections related to devices, often catheters, used to access patient veins. ProPublica sliced off the California data and shared it, so you can see the percent of each facility’s Medicare patients who reported a vascular access infection or septicemia, a serious bloodstream infection.

The statewide average suggests that 18 perceny of patients report an access-point infection and 11 percent report septicemia, a serious bloodstream infection (more details on this data are here). Both California averages are just a bit below the national averages of 20 percent and 12 percent, respectively.

Facility rates can skew far above or below those averages:




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