Post on 07-May-2015
Campaign to PreventAntimicrobial ResistanceDialysis Patients
Centers for Disease Control and Prevention National Center for Infectious Diseases Division of Healthcare Quality Promotion
Department of Health and Human Services
Link to: Campaign to Prevent Antimicrobial Resistance Online Link to: Federal Action Plan to Combat Antimicrobial Resistance
Campaign to Prevent Antimicrobial Resistance in Healthcare Settings
Link to: Campaign to Prevent Antimicrobial Resistance Online Link to: Federal Action Plan to Combat Antimicrobial Resistance
Campaign to Prevent Antimicrobial Resistance in Healthcare Settings
Clinicians
Hold the
Solution!
Emergence of Antimicrobial Resistance
Susceptible Bacteria
Campaign to Prevent Antimicrobial Resistance in Healthcare Settings
New Resistant Bacteria
Mutations
XX
Resistant Bacteria
Resistance Gene Transfer
Resistant StrainsRare
xx
Resistant Strains Dominant
xxxx
xx
xx
xxAntimicrobial Exposure
Selection for Antimicrobial-resistant Strains
Campaign to Prevent Antimicrobial Resistance in Healthcare Settings
Antimicrobial Resistance: Key Prevention Strategies
Optimize Use
PreventTransmission
PreventInfection
EffectiveDiagnosis& Treatment
PathogenAntimicrobial-Resistant Pathogen
Antimicrobial Resistance
Antimicrobial Use
Infection
Campaign to Prevent Antimicrobial Resistance in Healthcare Settings
Susceptible Pathogen
Key Prevention Strategies
Prevent infection Diagnose and treat
infection effectively
Use antimicrobials wisely
Prevent transmission
Campaign to Prevent Antimicrobial Resistance in Healthcare Settings
Clinicians hold the solution!
Campaign to Prevent Antimicrobial Resistance in Healthcare Settings
General health communication strategy Goals:
- inform clinicians, patients, and other stakeholders
- raise awareness about the escalating problem of antimicrobial resistance in healthcare settings
- motivate interest and acceptance of interventional programs to prevent resistance
Campaign to Prevent Antimicrobial Resistance in Healthcare Settings
12 Steps To Prevent Antimicrobial Resistance
Targeted intervention programs for clinicians caring for high risk patients- hospitalized adults - dialysis patients- hospitalized children - surgical patients- long - term care residents
Goal: Improve clinician practices & prevent antimicrobial resistance Partnership with professional societies; evidence base published in
peer-reviewed specialty journals Educational tools – web-based / didactic learning modules, pocket
cards, slide presentations, etc.
Campaign to Prevent Antimicrobial Resistance in Healthcare Settings
12 Steps to Prevent Antimicrobial Resistance: Dialysis Patients
12 Steps to Prevent Antimicrobial Resistance: Dialysis Patients
Prevent Transmission
Use AntimicrobialsWisely
Diagnose & TreatEffectively
Prevent Infection
12 Partner with your patients 11 Practice hand hygiene 10 Follow infection control precautions 9 Stop antimicrobial treatment 8 Treat infection, not contamination or colonization 7 Know when to say “No” to Vanco 6 Use local data 5 Access the experts 4 Target the pathogen 3 Optimize access care 2 Get the catheters out1 Vaccinate staff and patients
Disease Burden for Dialysis Patients
The number of patients with end-stage renal disease treated by maintenance hemodialysis in the US has increased during the past 30 years.¹
In 2001 more than 3,000 hemodialysis centers had greater than 250,000 chronic hemodialysis patients.2
Annual mortality rate among hemodialysis patients is 23% and infections are the second most common cause, accounting for 15% of deaths.¹
Hemodialysis patients are immunosuppressed and require frequent hospitalization and surgery, which increases their risk for resistant infections.¹
Vascular access infections (in hemodialysis patients) and peritonitis (in peritoneal dialysis patients) are the most common infections.¹
12 Steps to Prevent Antimicrobial Resistance: Dialysis Patients
1 CDC, MMWR 2001; 50 (5):132Unpublished data, Dialysis Surveillance Network
Fact: Influenza and pneumococcal vaccine given to both staff and patients will help to prevent infections requiring antimicrobial therapy.
Prevent InfectionStep 1: Vaccinate staff and patients
12 Steps to Prevent Antimicrobial Resistance: Dialysis Patients
Step 1: Vaccinate staff and patients
Vaccination Rates of Dialysis Patients,1999-2001*
01020304050
60708090
100
1999 2000 2001
Influenza Vaccine
PneumococcalVaccine
Healthy People 2010Goal
Link to: Influenza recommendations...CDC, MMWR 2003; 52 (RR08):1-36
* Unpublished data, Dialysis Surveillance Network
12 Steps to Prevent Antimicrobial Resistance: Dialysis Patients
Step 1: Vaccinate staff and patients
Need for Healthcare Personnel ImmunizationPrograms: Influenza Vaccination Rates (1996-97)
34%All healthcare personnel
38%Healthcare personnel at high risk
63%All adults > 65 yrs. of age
% Vaccinated
Source: 1997 National Health Interview SurveyWalker FJ, et al., Infect Control Hosp Epidemiol 2000; 21:113
Link to: ACIP Influenza Immunization Recommendations
12 Steps to Prevent Antimicrobial Resistance: Dialysis Patients
Step 1: Vaccinate staff and patients
Actions: Get influenza vaccine Give influenza / pneumococcal vaccine to patients in addition to routine vaccines (e.g., hepatitis B)
Prevent InfectionStep 1: Vaccinate staff & patients
Fact: Influenza and pneumococcal vaccine given to both staff and patients will help to prevent infections requiring antimicrobial therapy.
Link to: ACIP Influenza immunization recommendations Link to: CDC facts about influenza and pneumococcal vaccine Link to: ACIP: Vaccine standing orders
12 Steps to Prevent Antimicrobial Resistance: Dialysis Patients
Step 1: Vaccinate staff and patients
Link to: NNIS Online at CDC
Fact: Indwelling catheters are the single most important factor contributing to bacteremia in hemodialysis patients.
Prevent InfectionStep 2: Get the catheters out
12 Steps to Prevent Antimicrobial Resistance: Dialysis Patients
Step 2: Get the catheters out
Epidemiology of Catheter Associated Infections
Estimated attributable mortality for catheter-associated bloodstream infections ranges from 0% to 35%, depending on study design.
Primary risk factor for access infection is access type (catheters>grafts>fistulas).
The relative risk for bacteremia in patients with dialysis catheters is sevenfold the risk for patients with primary arteriovenous fistulas.
12 Steps to Prevent Antimicrobial Resistance: Dialysis Patients
Step 2: Get the catheters out
CDC, MMWR 2002, 51 (RR-10); p.10
Biofilm on Intravenous Catheter Connecter 24 Hours After Insertion
Scanning Electron Micrograph
Link to: Biofilms and device-associated infections
12 Steps to Prevent Antimicrobial Resistance: Dialysis Patients
Step 2: Get the catheters out
Rates of Bacteremia Infection by Access Type - Dialysis Surveillance Network 10/99-05/02
0.3 0.5
4.8
8.7
0.0
2.0
4.0
6.0
8.0
10.0
Fistula Graft CuffedCatheter
NoncuffedCatheter
Rat
e p
er 1
00 p
atie
nt-
mo
nth
s
Tokars et al., Am J Infect Control 2002;30:288-295.
12 Steps to Prevent Antimicrobial Resistance: Dialysis Patients
Step 2: Get the catheters out
Fact: Indwelling catheters are the single most important factor contributing to bacteremia in hemodialysis patients.
Actions: Hemodialysis:
Use catheters only when essential Maximize use of fistulas/grafts Remove catheters when they are no longer essentialPeritoneal Dialysis: Remove/replace infected catheters
Coming soon…guidelines for preventing catheter-associated bloodstream infections Link to: Urinary catheter infection prevention
Prevent InfectionStep 2: Get the catheters out
12 Steps to Prevent Antimicrobial Resistance: Dialysis Patients
Step 2: Get the catheters out
Link to: NNIS Online at CDC
Fact: Careful infection control prevents peritoneal dialysis related infections.
Prevent InfectionStep 3: Optimize access care
12 Steps to Prevent Antimicrobial Resistance: Dialysis Patients
Step 3: Optimize access care
Peritoneal Catheter Insertion and Management
Catheter insertion should be performed under operating room, sterile conditions.
Adherence to the principles of catheter insertion, management, and care remain the cornerstone of successful peritoneal dialysis access.
Despite improvements in catheter survival over the last few years, catheter-related complications still occur, causing significant morbidity and often forcing the removal of the catheter.
12 Steps to Prevent Antimicrobial Resistance: Dialysis Patients
Step 3: Optimize access care
Gokal et al., Peritoneal Dialysis International 1998;18:11-33.
Fact: Careful infection control prevents peritoneal dialysis-related infections.
Actions: Follow established guidelines for access care Use proper insertion and catheter-care protocols Remove access device when infected Use the correct catheter
Guidelines for preventing catheter-associated bloodstream infections, CDC, MMWR 2002 51 (RR10) Link to: Peritoneal Catheters and Exit-Site Practices 1998 Update
Prevent InfectionStep 3: Optimize access care
12 Steps to Prevent Antimicrobial Resistance: Dialysis Patients
Step 3: Optimize access care
Fact: Identifying the pathogen using microbiologic cultures and antimicrobial susceptibility testing allows for targeted antimicrobial therapy.
Diagnose & Treat EffectivelyStep 4:Target the pathogen
12 Steps to Prevent Antimicrobial Resistance: Dialysis Patients
Step 4: Target the pathogen
Importance of Utilizing Cultures and Antimicrobial Susceptibility Testing Results
No. (%) Susceptible___________________________________________________ Cefazolin Vanco Cefazolin and Vanco and
Gentamicin Gentamicin
___________________________________________________Blood Cultures 14 (78) 16 (89) 16 (89) 17 (94)(n=18)
Clinically SignificantCultures (n=146) 87 (60) 100 (68) 132 (90) 142 (97)
Fogel et al., Am J Kidney Dis 1998;32:401-409
12 Steps to Prevent Antimicrobial Resistance: Dialysis Patients
Step 4: Target the pathogen
CDC’s M.A.S.T.E.R. Improving Antimicrobial Susceptibility Testing Proficiency
12 Steps to Prevent Antimicrobial Resistance: Hospitalized Adults
Step 4: Target the pathogen
Fact: Identifying the pathogen using microbiologic cultures and antimicrobial susceptibility testing allows for targeted antimicrobial therapy.
Actions: Obtain appropriate cultures Target empiric therapy to likely pathogens Target definitive therapy to known pathogens Optimize timing,regimen,dose,route and duration
Link to: IDSA guidelines for evaluating fever in critically ill adults
Diagnose & Treat Effectively Step 4: Target the pathogen
12 Steps to Prevent Antimicrobial Resistance: Dialysis Patients
Step 4: Target the pathogen
Fact:Input from infectious diseases experts improves the outcome of serious infections.
12 Steps to Prevent Antimicrobial Resistance: Dialysis Patients
Step 5: Access the experts
Diagnose & Treat EffectivelyStep 5:Access the experts
Infectious Diseases Expert Resources
Infectious Diseases Specialists
Optimal Patient Care
Optimal Patient Care
Infection Control Professionals
Healthcare Epidemiologists
ClinicalPharmacists
Clinical Pharmacologists
Surgical InfectionExperts
ClinicalMicrobiologists
12 Steps to Prevent Antimicrobial Resistance: Dialysis Patients
Step 5: Access the experts
Fact: Input from infectious diseases experts improves the outcome of serious infections.
Action: Consult the appropriate experts for
complicated infections
Link to: SHEA / IDSA: Guidelines for the Prevention of Antimicrobial Resistancein Hospitals
Diagnose & Treat Effectively Step 5: Access the experts
12 Steps to Prevent Antimicrobial Resistance: Dialysis Patients
Step 5: Access the experts
Fact:The prevalence of resistance varies by locale
Use Antimicrobials WiselyStep 6: Use local data
12 Steps to Prevent Antimicrobial Resistance: Dialysis Patients
Step 6: Use local data
Percent of S. aureus Blood Isolates Resistant to Methicillin, by Dialysis Center
0
2
4
6
8
10
10 20 30 40 50 60 70 90
Percent Resistant to Methicillin
Nu
mb
er o
f D
ialy
sis
Cen
ters
Dialysis Surveillance Network 1999-20023
11 Centers, Canada, 10%1
10 Centers, Connecticut, 43%2
1Taylor et al., Infect Control Hosp Epidemiol 2002;23:716-7202 Dopirak et al., Infect Control Hosp Epidemiol 2002;23:721-7243 Unpublished data, Dialysis Surveillance Network
12 Steps to Prevent Antimicrobial Resistance: Dialysis Patients
Step 6: Use local data
Use Antimicrobials Wisely Step 6: Use local data
Fact: The prevalence of resistance varies by locale.
Actions: Know your local antibiogram Get previous microbiology results when
patients transfer to your facility
Link to: NCCLS Proposed Guidance for Antibiogram Development
12 Steps to Prevent Antimicrobial Resistance: Dialysis Patients
Step 6: Use local data
Fact: Reduction of vancomycin use is one of the most important strategies to limit the emergence, selection, and spread of vancomycin resistant bacteria.
Use Antimicrobials WiselyStep 7: Know when to say “No” to vanco
12 Steps to Prevent Antimicrobial Resistance: Dialysis Patients
Step 7: Know when to say “No” to Vanco
S. aureus
Penicillin
[1944] Penicillin-resistantS. aureus
Evolution of Drug Resistance in S. aureus
Methicillin
[1962]
Methicillin-resistantS. aureus (MRSA)
Vancomycin-resistantenterococci (VRE)
Vancomycin
[1990s]
[1997]
Vancomycinintermediate
S. aureus(VISA)
[2002]
Vancomycin-resistantS. aureus
12 Steps to Prevent Antimicrobial Resistance: Dialysis Patients
Step 7: Know when to say “ No” to Vanco
CDC, MMWR 2002;51(26):565-567
VRE Colonization Among Dialysis Patients Who Received Vancomycin
12 Steps to Prevent Antimicrobial Resistance: Dialysis Patients
Step 7: Know when to say “ No” to Vanco
Received Vancomycin Developed VRE
No 0/29 (0%)
Yes 16/61 (26%)
p<.001
Atta et al., Kidney International 2001;59:718-724
First Case of Vancomycin - Resistant S. aureus (VRSA)
First fully vancomycin resistant clinical isolate of S. aureus Michigan, June 2002 40-year old black female with diabetes mellitus, peripheral
vascular disease,on chronic hemodialysis VRSA from foot ulcer and catheter exit site During the 6 months preceding VRSA:
patient experienced 6 hospitalizations, totaling 18 days patient received multiple antimicrobial therapy, including 5.5 weeks of vancomycin
Chang S et al, New England J of Med 2003; 348:14,1342-3447
12 Steps to Prevent Antimicrobial Resistance: Dialysis Patients
Step 7: Know when to say “No” to Vanco
Vancomycin- Intermediate S. aureus (VISA)
State, Year Site PD/HD*Michigan, 1997 Peritonitis Chronic PDNew Jersey, 1997 Blood Recent PDNew York, 1998 Blood Chronic HDIllinois, 1999 Endocarditis Chronic HDMinnesota, 2000 Bone Chronic HDNevada, 2000 Liver -----
PD=peritoneal dialysis , HD=hemodialysis
Fridkin, Clin Infect Diseases 2001;32:111
12 Steps to Prevent Antimicrobial Resistance: Dialysis Patients
Step 7: Know when to say “No” to Vanco
Guidelines for Appropriate Vancomycin Use (HICPAC/CDC)
Selected situations in which the use of vancomycin is appropriate or acceptable: For treatment of serious infections caused by beta-
lactam-resistant gram-positive microorganisms. For treatment of infections caused by gram-positive
microorganisms in patients who have serious allergies to beta-lactam agents.
When antibiotic-associated colitis fails to respond to metronidazole therapy or is severe and potentially life-threatening.
12 Steps to Prevent Antimicrobial Resistance: Dialysis Patients
Step 7: Know when to say “No” to Vanco
CDC, MMWR 1995;44(RR12):1-13
Guidelines for Appropriate Vancomycin Use (HICPAC/CDC)
Selected situations in which the use of vancomycin should be discouraged: Treatment in response to a single blood culture positive for coagulase-negative
staphylococcus, if other blood cultures taken during the same time frame are negative.
Continued empiric use for presumed infections in patients whose cultures are negative for beta-lactam resistant gram-positive microorganisms.
Eradication of MRSA colonization. Systemic or local prophylaxis for infection or colonization of indwelling central or
peripheral intravascular catheters. Primary treatment of antibiotic-associated colitis. Routine prophylaxis for patients on continuous ambulatory peritoneal dialysis or
hemodialysis. Treatment (chosen for dosing convenience) of infections caused by beta-lactam-
sensitive gram-positive microorganisms in patients who have renal failure.
12 Steps to Prevent Antimicrobial Resistance: Dialysis Patients
Step 7: Know when to say “No” to Vanco
Use Antimicrobials WiselyStep 7: Know when to say “No” to vanco
Fact: Reduction of vancomycin use is one of the most important strategies to limit the emergence, selection, and spread of vancomycin resistant bacteria.
Action: Follow CDC guidelines for vancomycin use Consider 1st generation cephalosporins instead of
vancomycin
Link to: Methods to improve antimicrobial use and prevent resistance
12 Steps to Prevent Antimicrobial Resistance: Dialysis Patients
Step 7: Know when to say “No” to Vanco
Fact: A major cause of antimicrobial overuse is treatment of contamination or colonization.
Use Antimicrobials WiselyStep 8: Treat infection,not contamination or colonization
12 Steps to Prevent Antimicrobial Resistance: Dialysis Patients
Step 8: Treat infection, not contamination or colonization
Interpreting a Positive Blood CultureTrue Bacteremia: Unlikely Uncertain Likely
• S. aureus• S. pneumoniae• Enterobacteriaceae• P. aeruginosa• C. albicans
• Corynebacterium spp.• Non-anthracis Bacillus spp.• Propioniobacterium acnes
• coagulase-negative staphylococci
Kim SD, et al., Infect Control Hosp Epidemiol 2000;21:213-217
pre-test probabilitypatient risk factorsprosthetic devicesclinical evidence
post-test probability# positive / # cultures compare antibiograms compare genotypes
12 Steps to Prevent Antimicrobial Resistance: Dialysis Patients
Step 8: Treat infection, not contamination or colinization
Use Antimicrobials Wisely Step 8: Treat infection, not contamination or colonization
Fact: A major cause of antimicrobial overuse is treatment of contamination or colonization.
Actions: Use proper antisepsis for drawing blood cultures Get one peripheral vein blood culture, if possible Avoid culturing vascular catheter tips Treat bacteremia, not the catheter tip Culture the blood, not the skin or catheter hub
Link to: CAP standards for specimen collection and management
12 Steps to Prevent Antimicrobial Resistance: Dialysis Patients
Step 8: Treat infection, not contamination or colonization
Fact: Stopping empiric therapy when cultures are negative can significantly reduce antimicrobial use.
Use Antimicrobials WiselyStep 9: Stop antimicrobial treatment
12 Steps to Prevent Antimicrobial Resistance: Dialysis Patients
Step 9: Stop antimicrobial treatment
Short-course Antimicrobial Treatment of New Pulmonary Infiltrates in an ICU
Standard Experimental
Variable Therapy (n=42) Therapy (n=39)Regimen clinician discretion ciprofloxacin 400mg
(all treated; 18 drugs) (IV bid x 3 days)Treatment > 3 days 97% 28%
Antimicrobial resistance 35% 15%
Length of stay mean/median 14.7/9 days 9.4/4 days
Mortality (30 day) 31% 13%
Antimicrobial cost mean/total $640/$16,004 $259/$6,484
Link to: Singh N, et al.,Am J Respir Crit Care Med 2000;162:505-511
12 Steps to Prevent Antimicrobial Resistance: Dialysis Patients
Step 9: Stop antimicrobial treatment
Use Antimicrobials WiselyStep 9: Stop antimicrobial treatment
Fact: Stopping empiric therapy when cultures are negative can significantly reduce antimicrobial use.
Actions: Stop when infection is treated Stop when clinical and laboratory data
rule out infection
Link to: IDSA guideline for evaluating fever in critically ill adults
12 Steps to Prevent Antimicrobial Resistance: Dialysis Patients
Step 9: Stop antimicrobial treatment
Fact: Following the recommended infection control precautions for hemodialysis patients can prevent transmission of infections from patient to patient.
Prevent TransmissionStep 10: Follow infection control precautions
12 Steps to Prevent Antimicrobial Resistance: Dialysis Patients
Step 10: Follow infection control precautions
Infection Control Precautions for Hemodialysis Patients
In the hemodialysis setting, contact transmission plays a major role in
transmission of bloodborne and other pathogens. Infection Control Precautions for hemodialysis patients include:
Strict attention to hand hygiene using gloves for patient care and when handling patients medical equipment and
devices. Dedicating nondisposable items for use on a single patient. Cleaning and disinfection of items taken into a dialysis station that will be used for
more than one patient. For patients at increased risk for transmission of pathogenic bacteria,
including antimicrobial-resistant strains, additional precautions also might be necessary in some circumstances. For example, staff treating the patient should a) wear a separate gown over their usual clothing and b) dialyze the patient at a station with as few adjacent stations as possible.
12 Steps to Prevent Antimicrobial Resistance: Dialysis Patients
Step 10: Follow infection control precautions
Prevent Transmission Step 10: Follow infection control procedures
Fact: Following recommended infection control precautions for hemodialysis patients can prevent transmission of infections from patient to patient.
Actions: Use standard infection control precautions
for dialysis centers Consult local infection control experts
Link to: A VRE prevention success story Link to: CDC isolation guidelines and recommendations
12 Steps to Prevent Antimicrobial Resistance: Dialysis Patients
Step 11: Practice hand hygiene
Fact:
Hand hygiene is the single most important infection control measure for preventing the spread of antimicrobial resistant organisms.
Prevent TransmissionStep 11: Practice hand hygiene
12 Steps to Prevent Antimicrobial Resistance: Dialysis Patients
Step 11: Practice hand hygiene
Hand Hygiene Adherence in Hospitals
1. Gould D, J Hosp Infect 1994;28:15-30 2. Larson E, J Hosp Infect 1995;30:88-1063. Slaughter S, Ann Intern Med 1996;3:360-365 4. Watanakunakorn C, Infect Control Hosp Epidemiol 1998;19:858-860 5. Pittet D, Lancet 2000;356:1307-1312
Year of Study Adherence Rate Hospital Area
1994 (1) 29% General and ICU
1995 (2) 41% General
1996 (3) 41% ICU
1998 (4) 30% General
2000 (5) 48% General
12 Steps to Prevent Antimicrobial Resistance: Dialysis Patients
Step 11: Practice hand hygiene
Effectiveness of Hand Hygiene Agents in Reducing Bacteria on Hands
Adapted from: Hosp Epidemiol Infect Control, 2nd Edition, Philadelphia: Lippincott & Williams,1999.
Time after disinfection
Bac
teri
al R
edu
ctio
n
Plain soap
Antimicrobial soap(4% Chlorhexidine)
Alcohol-based handrub (70% Isopropanol)
Baseline
0 60 180 minutes
%
99.9
99.0
90.0
0.0
log
3.0
2.0
1.0
0.0
12 Steps to Prevent Antimicrobial Resistance: Dialysis Patients
Step 11: Practice hand hygiene
Fact: Hand hygiene is the single most important infection control measure for preventing the spread of antimicrobial resistant organisms.Actions:
Wash your hands or use alcohol-based handrub
Set an example!
Link to: Health guidelines for healthcare personnel Coming soon…new guidelines for hand hygiene
12 Steps to Prevent Antimicrobial Resistance: Dialysis Patients
Step 11: Practice hand hygiene
Prevent TransmissionStep 11: Practice hand hygiene
Fact:
Dialysis patients share in the responsibility for preventing access-related infections
Prevent TransmissionStep 12: Partner with your patients
12 Steps to Prevent Antimicrobial Resistance: Dialysis Patients
Step 12: Partner with your patients
Poor Patient Hygiene is a Risk Factor for Infection
No.(%) with Poor Hygiene
Patients Patients not p-value
Infected Infected
All Infections 17/23 (74%) 12/48 (25%) 0.0004
Access siteInfections 8/9 (89%) 21/62 (34%) 0.002
Kaplowitz et al., Infect Control Hosp Epidemiol 1988;9:534-541
12 Steps to Prevent Antimicrobial Resistance: Dialysis Patients
Step 12: Partner with your patients
Educating Patients About Infection Control Practices
• Patients should be educated about the importance of their role in infection control upon admission to a dialysis center/hospital and at least annually thereafter.
• Educational materials should include personal hygiene, hand hygiene, proper care of access lines, and recognition of signs of infection.
CDC, MMWR 2001;50 (5): 31
12 Steps to Prevent Antimicrobial Resistance: Dialysis Patients
Step 12: Partner with your patients
Fact: Dialysis patients share in the responsibility for preventing access-related infections.
Actions: Educate patients about proper access care
and infection control measures Re-educate regularly
Link to: Health guidelines for healthcare personnel Coming soon…new guidelines for hand hygiene
Prevent TransmissionStep 12: Partner with your patients
12 Steps to Prevent Antimicrobial Resistance: Dialysis Patients
Step 12: Partner with your patients
PREVENTION IS PRIMARY!
Protect patients…protect healthcare personnel…
promote quality healthcare!
Campaign to Prevent Antimicrobial Resistance in Healthcare Settings