While kidney transplantation, conservative care, and peritoneal dialysis are options for kidney failure, hemodialysis (HD) is the most utilized treatment of choice. For dialysis patients, infections are the leading causes of hospitalization and the second-leading cause of death. Learn more about concerns regarding hemodialysis-related infections and how they can be prevented.* 

What Puts Hemodialysis Patients at Risk for Bloodstream Infection?

In hemodialysis, a patient must have a device implanted in their body so the dialysis machine can access their bloodstream. The three most common types of devices are:

• Central venous catheter (CVC)
• Arteriovenous fistula (AVF)
• Arteriovenous graft (AVG) 

The infection risks vary with the type of device used, and research shows that CVCs carry the highest risk of bacterial infection from the person who handles the device, from the patient’s own skin, and from other environmental factors. 

Despite posing the greatest risk, CVCs are still commonly used as they allow for an immediate start to dialysis. AVFs and AVGs require a maturation time that can take weeks to months before they can be used. Due to this delay, patients may need a temporary CVC until their AVF or AVG is ready for action.

What Can Be Done to Decrease Infection Risk with CVCs?

While CVCs are riskier, there are some things you and your dialysis clinic can do to help prevent infection. These include:

• Adequately disinfecting the access site, such as using chlorhexidine gluconate for skin antisepsis
• Disinfecting CVC hubs before implantation and access
• Keeping the exit site clean and dry

In hemodialysis facilities, the risk for infections and illness, through direct or indirect contact, respiratory droplets, or airborne particles, is increased due to the close proximity of patients to healthcare workers and other patients. While not always preventable, there are standard precautions recommended to decrease the risk for patients and workers. This includes:

• Conscientious hand hygiene (especially with alcohol-based sanitizer)
• Use of personal protective equipment, such as face masks and gowns
• Proper preparation, handling, administration, and storage of needles and parenteral (non-oral) medication
• Safe handling of potentially contaminated equipment or surfaces in the patient environment
• Correct respiratory hygiene/cough etiquette

How Else Can We Reduce Risk?

Other important tools for preventing infections are screening and immunization. With proper screening, hepatitis B virus (HBV), hepatitis C virus (HCV), and tuberculosis can be detected early, which can help prevent transmission to other patients. Immunization is also available for HBV, pneumococcal disease, influenza, and COVID-19, which may also help protect vulnerable patients. 

Each dialysis clinic does have safety rules to follow to prevent infection. Some clinics are better than others in implementing them, however. As a patient, it’s important to ask questions, learn what the safety rules are for your facility, and speak up when you see anything that causes you concern. You have the right to a safe environment for your care. 

*Millson, T. D. (2022, March 23). Infection Prevention and Control Are Crucial in Dialysis Settings. Infection Control Today. https://www.infectioncontroltoday.com/view/infection-prevention-control-crucial-dialysis-settings

Wyoming Department of Health. (2017, June 26). Section 13: Current Infection Prevention Issues in Dialysis. https://health.wyo.gov/publichealth/infectious-disease-epidemiology-unit/healthcare-associated-infections/infection-prevention-orientation-manual/dialysis/