Canadian Journal of Infection Control | Spring 2019 | Volume 34 | Issue 1 | 54-57 CONCISE REPORT INTRODUCTION Minimization of line-related bloodstream infections and establishing dialysis access are often challenging tasks in hemodialysis facilities for patients requiring renal replacement therapy. A number of factors, including patient reluctance, anatomic host factors, and prolonged maturation time, have contributed to a preponderance of dialysis catheter use. Many scientifc societies and the U.S. Centers for Disease Control and Prevention have suggested different measures to prevent catheter-related bloodstream infections (CRBSIs) [1]. Many promising articles targeting the prevention of CRBSIs have been published since the publication of these guidelines in 2011. One of the measures for prevention is to encourage fstula creation and usage. National quality improvement programs, which included the breakthrough Fistula First Initiative, have been shown to be ineffective and, in many instances, have Efective prevention bundle to eliminate catheter-related bloodstream infections in ambulatory hemodialysis patients Hoda A. Hamid; 1 Hicham Bouanane; 1 Athar Ibrahim; 1 Sahar Ismail; 1 Aisha El Sayed; 1 Khaled M. Mahmoud; 2 Abdulla Hamad; 2 Fadwa Al Ali 2 1 Fahd Bin Jassim Kidney Center, Hamad General Hospital, Doha, Qatar 2 Nephrology Unit, Hamad General Hospital, Doha, Qatar Corresponding author: Khaled Mahmoud, MD, PhD, FASN Nephrology Unit, Hamad General Hospital, PO 3050, Doha, Qatar Tel.: 009744439599 kmohamed8@hamad.qa contributed to many patients on hemodialysis (HD) initiating renal replacement therapy with a catheter. Up to 80% of patients undergoing maintenance HD in the United States initiate treatment via a central venous catheter (CVC) with signifcantly more infections than arteriovenous fstulae or grafts [2]. CRBSIs were not well defned until 2009, when the Infectious Diseases Society of America recognized the unique characteristics of HD catheters. The defnition relied on obtaining a blood specimen from the dialysis catheter and an additional specimen from a peripheral vein [3]. The existence of a similar colony count, differential, and time-to-sensitivity at both sites are the criteria for diagnosis of a CRBSI in the absence of alternative sources of infection upon clinical evaluation. It should be noted that indwelling vascular catheters are colonized by microorganisms within 24 hours after their insertion. Bacteria are introduced into the lumen through ABSTRACT Background: Hamad General Hospital (HGH) is the principal provider of dialysis in the state of Qatar, comprising a total of four facilities in different cities. Infection rates in dialysis patients are increasingly used as a surrogate marker for measuring patient safety and quality of healthcare. These infections are associated with substantial morbidity, mortality, and excess healthcare costs. We observed an elevated rate of hemodialysis catheter-related bloodstream infections (HD-CRBSI) in our outpatient dialysis facilities (1.4/1,000 Central Venous Catheter [CVC] days) in 2011. Our goal was to reduce our HD-CRBSI rate by 80% within a period of four years in HGH ambulatory dialysis facilities. Methods: HD-CRBSIs are defned as the presence of positive blood cultures in a febrile catheter-dependent patient in the absence of alternative sources of infection upon clinical evaluation. The project was led by the HGH quality improvement program director in coordination with a multidisciplinary team (nephrologists, nurses, vascular coordinators, a patient educator, and an infection control team) after implementation of a bundle of infection prevention measures. Results: The rate of HD-CRBSI was reduced from 1.4/1,000 CVC days in 2011 to 0.014 in 2017, achieving a 99% reduction rate (p < 0.001). Conclusions: Strict implementation of our new infection prevention measures bundle is suffcient to signifcantly reduce HD-CRBSIs. KEYWORDS Prevention; hemodialysis catheter; bloodstream; infection Acknowledgements: None. Conflicts of interest: None. Funding: None. 54 Return to TABLE OF CONTENTS