Florida Department of Health: Reducing Bloodstream Infections in Hemodialysis Centers

Since 2011, the Florida Department of Health’s Health Care-Associated Infection Prevention Program has used the Centers for Disease Control and Prevention's National Healthcare Safety Network (NHSN) HAI data metrics for surveillance and prevention efforts, including analysis of data entered by hemodialysis facilities reporting bloodstream infections (BSI). This data has been instrumental in successfully identifying and responding to a rapid increase in BSI events.

In partnership with the CDC Making Dialysis Safer Coalition, the HAI Prevention Program addressed this public health challenge and strategically utilized evidenced-based interventions, toolkits, checklists and resources to reduce BSI events across Florida. The development of the Infection Control Assessment and Response, or ICAR tools, for hemodialysis facilities aids in identifying gaps in infection prevention and control practices classified in 11 domains for assessment. These domains include training, auditing, surveillance and disease reporting, personal protective equipment, environmental cleaning and injection safety. The HAI program evaluated individual facility standardized infection ratios (SIR) every six months to identify those with a higher-than-expected SIR, or a SIR greater than one.

Twelve hemodialysis facilities participated in the new ICAR tool initiative launched in 2017, consisting of direct infection prevention and control practice observations and policy reviews conducted by trained HAI program infection preventionists. The facilities received onsite and written feedback reports highlighting mitigation strategies, evidence-based recommendations, and resources from the coalition and NHSN. Since December 2021, the Florida Department of Health’s HAI program has responded and provided outreach to 94 hemodialysis facilities. Through this continued response, Florida’s standardized infection ratio has decreased from 13% (2020) to 10% (2021) to 8% (2022).

According to Argentina Charles, HAI prevention program manager, “The integration of the ICAR tool — combined with effective data-driven interventions, evidence-based practices and ongoing expansion of multidisciplinary subject matter experts — has strengthened Florida’s BSI response and improved patient and public health safety across the continuum of health care.”