Dialysis Surveillance Report: National Healthcare Safety Network (NHSN)-data summary for 2006.

Thirty-two outpatient hemodialysis providers in the United States voluntarily reported 3699 adverse events to the Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network (NHSN) during 2006. These providers were previously enrolled in the Dialysis Surveillance Network. The pooled mean rates of hospitalization among patients with arteriovenous fistulas, grafts, permanent and temporary central venous catheters were 7.7, 9.2, 15.7, and 34.7 per 100 patient-months, respectively. For bloodstream infection the pooled mean rates were 0.5, 0.9, 4.2, and 27.1 per 100 patient-months in these groups. Among the 599 isolates reported, 461 (77%) represented access-associated blood stream infections in patients with central lines, and 138 (23%) were in patients with fistulas or grafts. The microorganisms most frequently identified were common skin contaminants (e.g., coagulase-negative staphylococci). In 2007, enrollment in NHSN opened to all providers of outpatient hemodialysis. Specific information is available at http://www.cdc.gov/ncidod/dhqp/nhsn_FAQenrollment.html.

Electronic reporting of infections associated with hemodialysis.

UNLABELLED: Monitoring infections and antibiotic resistance patterns in dialysis populations is an important component of efforts to improve patient safety and quality of health care. The objective of this report is to update findings from the Dialysis Surveillance Network and describe the soon-to-be-available National Healthcare Safety Network. METHODS: Volunteer dialysis centers in the DSN submitted reports of hospitalizations, outpatient intravenous antimicrobial starts, and positive blood cultures. From these reports, an online system calculated rates of important adverse events. For this report, we summarize adverse-event data submitted to the DSN from September 1999 through March 2005. RESULTS: There were 53,804 events in the 321,519 patient-months during the period of analysis. The rate of hospitalization was 13 per 100 patient-months; the rate of outpatient IV vancomycin starts was 3 per 100 patient-months. The rate of vascular access infection was 3.1 per 100 patient-months and varied from 0.6 for fistulas to 10. 1.for temporary catheters. Of the 8,359 blood isolates reported, 77% (6,427) were primary bacteremias (5,275 were catheter-associated, 1,152 were fistula- or graft-associated), 19% (1,587) were secondary bacteremias, and 4% (345) were contaminants. CONCLUSIONS: Infection-related adverse events remain lowest among patients with vascular access in the form of fistulas and grafts. In the future, adverse events in dialysis will be monitored in the NHSN. The new, Web-based, NHSN surveillance system allows centers to monitor their rates and compare with other outpatient dialysis centers. In 2006, CDC plans to open enrollment for outpatient dialysis centers not already in the DSN.

The changing face of surveillance for health care-associated infections.

Surveillance of health care-associated infections and antimicrobial resistance is an important aspect of prevention. In 2004, the Centers for Disease Control and Prevention had 3 national health care surveillance systems. During 2004-2005, these will be combined into a single Internet-based system, the National Healthcare Safety Network (NHSN). The NHSN will feature a number of enhancements, and ultimately, all US hospitals and other health care facilities will be encouraged to participate. Health care surveillance using standard methods has been very useful and is cited as a model for prevention. However, alternative approaches may improve health care surveillance by reducing complexity, decreasing the burden of data collection, and improving accuracy. These alternative approaches include adopting simpler methods and more-objective definitions, using sampling and estimation, substituting information in computer databases for manually collected data, and increasing surveillance for process measures with known prevention efficacy. Maintaining successful features of standard systems, adopting alternate surveillance approaches, and exploiting new technologies, such as the Internet, will make health care surveillance an even better tool for prevention.

APIC position paper: Improving health care worker influenza immunization rates.

The Association for Professionals in Infection Control and Epidemiology (APIC) is a non-profit, international organization governed and directed by a board of directors, consisting of four officers and 10 directors. APIC has more than 110 regional Chapters in the United States and more than 10,000 members worldwide. As an authority in infection control, APIC endorses the Advisory Committee on Immunization Practices' (ACIP) recommendations published by the Centers for Disease Control and Prevention (CDC) in Morbidity and Mortality Weekly Reports