A cluster of gram-negative bloodstream infections in Connecticut hemodialysis patients associated with contaminated wall boxes and prime buckets.

BACKGROUND: Maintenance hemodialysis (HD) patients are at increased risk of bloodstream infections (BSI). We investigated a cluster of Delftia acidovorans infections among patients undergoing HD at an outpatient unit (Facility A). METHODS: A case was defined as a Facility A HD patient with ≥1 culture positive for D acidovorans between February 1 and April 30, 2018. An investigation included review of patient records, facility policies, practice observations, and environmental cultures. RESULTS: The cluster included 2 patients with confirmed D acidovorans BSI. Both patients had recently been dialyzed at Station #2, where a wall box culture yielded D acidovorans. One patient also had a BSI due to Enterobacter asburiae, which was recovered from several other wall boxes and saline prime buckets (SPB). Observations revealed leakage of wastewater from wall boxes onto the floor, and that SPBs were not always disinfected and dried appropriately before reuse. Multiple deficiencies in hand hygiene and station disinfection were observed. No deficiencies in water treatment practices were identified, and water cultures were negative for the observed pathogens. CONCLUSIONS: The cluster of D acidovorans infections was most likely due to indirect exposures to contaminated wall boxes and possibly SPBs due to poor hand hygiene and station disinfection.

Surveillance of hemodialysis-associated primary bloodstream infections: the experience of ten hospital-based centers.

OBJECTIVE: To determine baseline rates of primary bloodstream infection (BSI) among a large pool of patients receiving hemodialysis using standardized surveillance tools and methodology. DESIGN: Prospective, descriptive analysis of primary BSI rates. SETTING: Ten hospital-based hemodialysis centers in Connecticut. PATIENTS: All patients receiving long-term hemodialysis in the participating facilities. RESULTS: A total of 158 BSIs occurred during 142,525 dialysis sessions within a 12-month study period. Of the BSIs, 15.2% occurred in patients with fistula or graft access and 84.8% in patients with central venous catheter access (P < .001). Rates per 100 patient-years in centers ranged from 0 to 30.8, with a mean of 16.6. Rates per 1,000 dialysis sessions ranged from 0 to 2.1, with a mean of 1.1. Coagulase-negative staphylococci and Staphylococcus aureus (including methicillin-resistant S. aureus) accounted for 61% and Klebsiella or Enterobacter species for 14.6% of infections. Of the patients, 63.3% received vancomycin, 24.7% received cefazolin, and 41.7% received aminoglycosides. Rates declined in the second 6 months of the study from 1.4 to 0.8 infections per 1,000 dialysis sessions (P < .001). CONCLUSIONS: Primary BSI rates varied widely among participating centers and declined during the study period. BSIs were strongly associated with central venous catheter access. Further studies are needed to determine the reasons for variance in rates between centers and among various types of hemodialysis access.