Current challenges and developments Infection prevention in dialysis The global incidence of kidney failure requiring dialysis is steadily rising. Over 3.5 million people worldwide, including approximately 540,000 in the United States, undergo maintenance hemodialysis or peritoneal dialysis to manage chronic kidney failure [1]. Dialysis is a life-saving therapy and carries a significant risk as dialysis patients have a weakened immune system and require regular vascular access, making them highly susceptible to infection. Central line-associated bloodstream infections (CLABSIs) in particular are a major driver of morbidity, mortality, and healthcare costs [2]. Therefore, infection prevention and improving patient care are highly relevant [2-4]. Especially multi-drug resistant organisms (MDROs) and pathogens that require special hygiene measures, such as Clostridioides difficile, pose a growing threat in the outpatient dialysis sector [5-8]. MRGN and C. difficile require special hygiene measures C. difficile infections are the most important spore-caused healthcareassociated infections in EU [12]. Dialysis patients have a 2 to 2.5 times higher risk of C. difficile infection – with serious consequences: their mortaReferences: 1. Flythe JE, Watnick S (2024) Dialysis for Chronic Kidney Failure: A Review. 12;332(18):1559-1573. doi: 10.1001/jama.2024.16338. PMID: 39356511. 2. Fisher M et al. (2019) Clin J Am Soc Nephrol 15(1): 132–151. 3. Rayner H et al. (2004) Nephrology Dialysis Transplantation 19(1): 108–120. 4. Boyce J (2012) Infect Control Hosp Epidemiol 33(9): 936–944. 5. Epidemiological Bulletin 20/21/2025 (2025) Report by the NRZ on Gram-negative hospital pathogens 2024. https://www.rki.de/DE/Aktuelles/Publikationen/ Epidemiologisches-Bulletin/2025/20-21_25.pdf?__blob=publicationFile&v=4 (accessed on 07.02.2026) 6. KRINKO (2012) Bundesgesundheitsbl 55(10): 1311–1354. 7. KRINKO (2019) Bundesgesundheitsbl 62: 906–923. 8. Chitnis et al. (2013) JAMA Intern Med 173(14): 1359-1367. 9. D’Agata E et al. (2021) Kidney Int 99(5): 1045–1053. 10.Zacharioudakis et al. (2015) Am J Kidney Dis 65(1): 88-97. 11. Calfee (2015) Am J Kidney Dis 65(1):3-5. 12. Zacharioudakis et al.(2014) J Am Soc Nephrol 25(9):2131-2141. 13. European Centre for Disease Prevention and Control (ECDC) (2024) Point prevalence survey of healthcare-associated infections and antimicrobial use in European acute care hospitals, 2022-2023. https://www.ecdc.europa.eu/en/publications-data/PPS-HAI-AMR-acute-care-europe-2022-2023 (accessed on 07.02.2026) 14. German Society of Nephrology (ed.). Guideline on infection prevention and hygiene 2019 as a supplement to the dialysis standard. https://www.dgfn.eu/dialysestandard.html?file=files/content/leitlinien/hygieneleitlinie/20200127_LL-Hygiene-Einzelseiten.pdf lity rate in the event of infection is twice as high as that of the general population [9]. In a meta-analysis of 23 studies, Zacharioudakis et al. found that the prevalence of Vancomycin-resistant enterococci (VRE) colonisation among dialysis patients is 6.2%. However, it is not only VRE that poses an increased risk to dialysis patients; other MDROs do, too. A separate meta-analysis by the same group showed that the prevalence of MRSA colonisation among dialysis patients was equal to that of VRE. In his editorial, David Calfee likens the situation with MDROs to the ‘perfect storm‘ of 1991. At that time, three atmospheric conditions created the ideal conditions for this storm. In dialysis, it is epidemiological factors that create optimal conditions for morbidity and mortality related to infection. These factors include frequent antibiotic use, invasive procedures, and immune deficiency [10-12]. MDROs and C. difficile are increasingly emerging as significant challenges in outpatient dialysis settings. Ensuring proper hand and surface hygiene, along with the consistent use of gloves, remains essential for preventing infections [14]. Hygiene measures at a glance For further information, please see our poster on hygiene measures during dialysis: https://hartmannsciencecenter.com/p3DuHU Before each indication and for every new patient: disinfect your hands and don gloves, when necessary!* Follow guidance on patient-related glove use. Hygiene during dialysis * Medical disposable gloves 3ml 30 s Hygienic hand disinfection Preparing i.v. medication/ infusions Injecting i.v. medication Punctures Connecting/disconnecting the patient Handlingshunt/catheter/ tubing system Changing dressings Examples of aseptic tasks BEFORE BEFORE AFTER AFTER AFTER patient contact aseptic tasks contact with potentially infectious materials patient contact contact with the immediate patient environment Surface disinfection Ensure complete wetting of surfaces. Follow contact times! starting dialysis preparing medications catering visible contamination ending dialysis BEFORE AFTER BEFORE BEFORE AFTER AFTER Wipe disinfection of work surfaces and all contact surfaces Preparation of i.v. medication/infusions Catering for patients Visible contamination of work and contact surfaces 221 local access site infections Vor jeder neuen Indikation und jedem Patientenwechsel gilt: Händedesinfektion und ggf. Handschuhe!* Handschuhe patientenbezogen und indikationsgerecht verwenden. Hygiene bei der Dialyse * Medizinische Einmalhandschuhe 3ml 30 s Hygienische Händedesinfektion Vorbereitung von i.v. Medikamenten/ Infusionen Zuspritzen von i.v. Medikamenten Punktionen Konnektion/ Diskonnektion Dialysegerät Arbeiten am Shunt/Katheter/ Schlauchsystem Verbandwechsel Beispiele für aseptische Tätigkeiten VOR VOR NACH NACH NACH Patientenkontakt aseptischen Tätigkeiten Kontakt mit potenziell infektiösen Erregern Patientenkontakt Kontakt mit der direkten Patientenumgebung Flächendesinfektion Flächen vollständig benetzen. Einwirkzeiten beachten! Beginn der Dialyse der Vorbereitung von Medikamenten der Bewirtung sichtbarer Verschmutzung Ende der Dialyse VOR NACH VOR VOR NACH NACH Wischdesinfektion der Arbeitsfläche und aller Kontaktflächen Vorbereitung von i.v. Medikamenten/ Infusionen Bewirtung von Patienten Sichtbare Verschmutzung von Arbeits- und Kontaktflächen 439 intravenous antimicrobial starts Vor jeder neuen Indikation und jedem Patientenwechsel gilt: Händedesinfektion und ggf. Handschuhe!* Handschuhe patientenbezogen und indikationsgerecht verwenden. * Medizinische Einmalhandschuhe Vorbereitung von i.v. Medikamenten/ Infusionen Zuspritzen von i.v. Medikamenten Punktionen Konnektion/ Diskonnektion Dialysegerät Arbeiten am Shunt/Katheter/ Schlauchsystem Verbandwechse Beispiele für aseptische Tätigkeiten NACH NACH Patientenkontakt Kontakt mit der direkten Patientenumgebung Flächendesinfektion Flächen vollständig ben Einwirkzeiten beachten Beginn der Dialyse der Vorbereitung von Medikamenten der Bewirtung sichtbarer Verschmutzung Ende der Dialyse VOR NACH VOR VOR NACH NACH Wischdesinfektion der Arbeitsfläche und aller Kontaktflächen Vorbereitung von i.v. Medikamenten/ Infusionen Bewirtung von Patienten Sichtbare Verschmutzung von Arbeits- und Kontaktflächen 63 bloodstream infections 723 DAIEs In total, 43 outpatient dialysis facilities reported 723 dialysis-associated infection events (DAIE), including 63 bloodstream infections, 439 intravenous antimicrobial starts, and 221 local access site infections. KNOWLEDGE 5
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