Abstract
KEY POINTS: In 2020, 7183 hemodialysis facilities in the United States reported bloodstream infection data for over five million patient-months to the Centers for Disease Control and Prevention's National Healthcare Safety Network. Pooled mean bloodstream infection rates per 100 patient-months ranged from 0.12 among patients with arteriovenous fistulas to 0.80 among patients with central venous catheters. Rates of bloodstream infection were lower than predicted overall and in almost all states and territories. BACKGROUND: Approximately 500,000 people in the United States undergoing hemodialysis are at risk of bloodstream infections (BSIs). The Centers for Disease Control and Prevention's National Healthcare Safety Network conducts surveillance for BSIs among outpatient hemodialysis facilities in the United States. 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 United States during 2020, stratified by state or territory. METHODS: Outpatient hemodialysis facilities report BSI events to the National Healthcare Safety Network. Pooled mean rates with 95% confidence interval (CI) were calculated overall and for each type of vascular access (arteriovenous [AV] fistula, AV graft, or a central venous catheter). Standardized infection ratios (SIRs) were calculated as observed BSI events divided by the predicted number of events on the basis of national aggregate data. Median facility-level SIRs and 95% CIs were stratified by state and US territory. RESULTS: During 2020, 7183 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 to 0.30) overall, 0.80 (95% CI, 0.78 to 0.82) for central venous catheter, 0.12 (95% CI, 0.12 to 0.12) for AV fistula, 0.21 (95% CI, 0.20 to 0.22) for AV graft, and 0.28 (95% CI, 0.19–0.40) for other access types. The national SIR was 0.40 (95% CI, 0.39 to 0.41). South Dakota had a SIR significantly higher than one (1.34; 95% CI, 1.11 to 1.62). Fifty-one of 54 states and territories had BSI SIR significantly lower than one. CONCLUSIONS: In 2020, the median SIR for BSI in US outpatient hemodialysis facilities was lower than predicted overall and in almost all states and territories. An elevated SIR was identified in South Dakota.