Embracing collaboration: A novel strategy for reducing bloodstream infections in outpatient hemodialysis centers

Background The incidence of access-related bloodstream infections (AR-BSIs) in US outpatient hemodialysis centers is unacceptably high. This paper presents the implementation and results achieved from a multi-pronged strategy to reduce AR-BSIs in 1 outpatient hemodialysis center. Methods The intervention, which took place between 2009 and 2011, involved membership in the Centers for Disease Control and Prevention Hemodialysis Bloodstream Infection Prevention Collaborative, implementation of a panel of infection prevention interventions, and use of positive deviance (PD) to engage staff. Changes in the incidence of AR-BSIs and infection prevention process measures between the pre- and postintervention time periods, as well as alterations in the center's social networks, were examined to assess impact. Results The incidence of all AR-BSIs dropped from 2.04 per 100 patient-months preintervention to 0.75 ( P = .03) after employing the Collaborative interventions and to 0.24 ( P