QIA Guidelines

The Network will:

o Assist facilities to implement and monitor all of the CDC recommended interventions for dialysis BSI prevention
o Educate target facilities on the CDC Core Interventions, and assist the facilities in implementing the CDC Core Interventions
o Assist Facilities in monitoring their own progress toward implementing the CDC Core Interventions and reduction of BSIs, and
o Involve Patient SMEs, family members, or care partners in discussion about infection control practices and ways to encourage patients to bring issues and suggestions to the attention of staff members

Facility Selection/Inclusion Criteria:  at least 50% of facilities in the Network’s service area including those facilities reporting the highest BSI rates.


ESRD National Coordinating Center (ESRD NCC)
     National HAI QIA Learning and Action Network (ESRD NCC HAI LAN) recordings
     National Patient Subject Matter Experts Affinity Group webpage
The Centers for Disease Control and Prevention (CDC)
Dialysis Core Interventions  webpage
     Clean Hands Count webpage
     Get Ahead of Sepsis webpage
New York State Department of Health
     One and Only Campaign Safe Injections Practices Coalition webpage


Participate in ESRD NCC HAI LAN:  Network and targeted facility staff are required to participate in the bi-monthly ESRD HAI LAN (1 hour webinar with nursing CE).  This LAN has two primary purposes. The first is to improve information communication across care settings, with emphasis on communication between hospitals and dialysis centers caring for the same ESRD patients. The second is to increase awareness of and implementation of CDC Core interventions.

Network Guidance:
Provide the facilities in the BSI QIA with guidance to implement all CDC recommended interventions for dialysis BSI prevention (Surveillance and feedback using NHSN, hand hygiene observations, catheter/vascular access care observations, staff education and competency, patient engagement/education, catheter reduction, chlorhexidine for skin asepsis, catheter hub disinfection, and antimicrobial ointment) that the facility has not adopted or is having difficulty successfully implementing.

Incorporate action steps developed from each ESRD NCC HAI LAN to assist facilities in implementing the COR interventions.

Encourage the dialysis facilities to discuss the use of the CDC Core Interventions at QAPI meetings, in addition to infection rates, with the Medical Director for the facility.

Assist facilities to complete a root cause analysis if there was successful implementation of all the CDC Core Interventions if the BSI rate did not decrease by at least 10% during the QIA.

Encourage facilities to participate in CDC HAI training activities by encouraging all clinical staff to complete the CDC Infection Prevention in Dialysis Settings Continuing Education course as well as view the CDC video “Preventing Bloodstream Infections in Outpatient Hemodialysis Patients: Best Practices for Dialysis Staff”.

Reduce Long Term Catheter (LTC) Use Activities

Criteria:  Use NCC provided data to identify facilities with a LTC (catheter in use > 90 days) in use rate above 15% (from the 50% of facilities in the Network’s service area reporting the highest BSI rates)

LTC Goal:
 Decrease rate by at least 2 percentage points by evaluation based on June 2017 baseline data
BSI Goal:  Demonstrate a 20% or greater relative reduction in the semi-annual pooled mean in the cohort with the highest 20% of BSIs in the Network service area at re-measurement compared to 2017

Graduation Requirements: A facility may be removed and replaced for 2019 in the QIA if it is no longer in the cohort of facilities with the highest 20% of BSIs in the Network service area or maintains a BSI rate of zero for at least six (6) months of the QIA

CMS Recommended Learning Activity:
Prevention of intravascular infections, blood-borne pathogen transmission (e.g., hepatitis B), and influenza and pneumococcal disease are priorities identified in the National Action Plan to Prevent Healthcare-Associated Infections: Roadmap to Elimination

Tools and Resources

CDC Resources:
Four ways to get ahead of Sepsis flyer PDF
What Got You Sick? Viruses or Bacteria? flyer PDF



June 5, 2018Environmental Cleaning and DisinfectionSheila Segura
• Describe the relationship between the healthcare environment and infection prevention.
• Review the Centers for Disease Control and Prevention (CDC) recommendations to reduce healthcare associated infections (HAI) in the dialysis setting.
• Identify practices to reduce the risk of environmentally-related healthcare- associated infections.
Does not support Core Intervention but does support CDC research of HAI prevention.https://esrdncc.org/en/events/20182/june-2018/bsi-qia-lan/?date=6/1/2018
April 3, 2018Pathway to Hemodialysis Catheter Related Bloodstream Infection (CRBSI) ReductionSonia Shepherd
• Define challenges of the acute kidney injury/failure, end stage renal disease, and nursing home or long-term ambulatory care (LTAC) patient population.
• Highlight recognized issues contributing to the increase of bloodstream infection (BSI) rates and hospitalization.
• Identify how to improve collaboration with other healthcare providers.
Step 7: Chlorhexidine for skin antisepsis
Step 8: Catheter hub disinfection
January 29, 2018Reducing Bloodstream Infections and SepsisRochelle Whitmore, MSN, CRRN
Deborah Bowe, RN, CNN
• Promote implementation of the Centers for Disease Control (CDC) recommended core interventions for dialysis BSI prevention.
• Share best practices in reducing Healthcare- Associated Infections, BSIs, and sepsis.
• Discuss sepsis assessment tool development and implementation within one dialysis unit in the Midwest Kidney Network (ESRD Network 11).
Step 2: Hand hygiene observations
Step 3: Catheter/vascular access care observation
Step 4: Staff education and competency
Step 8: Catheter hub disinfection


For more information:

Jeanine Pilgrim 
Quality Improvement Director
 (516) 209-5365

Anna Bennett
Quality Improvement Coordinator
Emergency Manager
 (516) 209-5474

John Cocchieri
Data Coordinator, Quality Improvement
 (516) 209-5515