A Six-Year Follow-Up of Bloodstream Infections in Hemodialysis Facilities in the United States, National Healthcare Safety Network, 2020

The approximately 500,000 people in the US undergoing hemodialysis are at risk for bloodstream infections (BSIs). The Centers for Disease Control and Prevention’s National Healthcare Safety Network (NHSN) conducts surveillance for BSIs among outpatient hemodialysis facilities in the US. Quality improvement initiatives encourage these facilities to adopt evidence-based interventions to decrease the incidence of BSI in patients. We describe the incidence of BSI among patients at outpatient hemodialysis facilities in the US during 2020, stratified by state or territory. Methods Outpatient hemodialysis facilities report BSI events to NHSN. Pooled mean rates with 95% CI were calculated overall and for each type of vascular access (arteriovenous (AV) fistula, AV graft, or a central venous catheter (CVC)). Standardized infection ratios were calculated as observed BSI events divided by the predicted number of events based on national aggregate data. Median facility-level standardized infection ratios and 95% confidence intervals (CIs) were stratified by state and US territory. Results During 2020, 7,183 outpatient hemodialysis facilities reported data for 5,235,234 patient months with 15,181 BSI events. Pooled mean rates per 100 person-months were 0.29 (95% CI, 0.29-0.30) overall, 0.80 (95% CI, 0.78-0.82) for CVC, 0.12 (95% CI, 0.12-0.12) for AV fistula, 0.21 (95% CI, 0.20-0.22) for AV graft, and 0.28 (95% CI, 0.19-0.40) for other access types. The national standardized infection ratio was 0.40 (95% CI, 0.39-0.41). South Dakota had a standardized infection ratio significantly higher than one (1.34; 95% CI, 1.11 – 1.62). Fifty-one of 54 states and territories had BSI standardized infection ratio significantly lower than one. Conclusions In 2020, the median standardized infection ratio for BSI in US outpatient hemodialysis facilities was lower than predicted overall and in almost all states and territories. An elevated standardized infection ratio was identified in South Dakota.