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Filtering Out the Bad: Healthcare Worker Compliance of Dialysis Practices in a Pediatric Setting

Czernikowski, Dara (2023) Filtering Out the Bad: Healthcare Worker Compliance of Dialysis Practices in a Pediatric Setting. Master Essay, University of Pittsburgh.

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Central line associated bloodstream infections (CLABSIs) are one of the costliest healthcare associated infections to patient health and hospitals, incurring approximately $48,000 in extra expenses per episode. Without proper maintenance of central line sites, pathogens like Staphylococcus aureus and Enterococcus genus organisms can colonize and develop infection in the body. CLABSIs occur in 70% of hemodialysis patients, made more susceptible to this infection from the direct bloodstream access provided by their central lines. The infection prevention team at UPMC Children’s Hospital of Pittsburgh performed surveillance of current dialysis practices by staff over two months. Through this audit process, the objective was to review whether any areas in the dialysis procedure required improvement based on staff compliance. The team expected overall good compliance and aimed to provide feedback on improving compliance rates, if necessary, standardize methods across the UPMC system, and mitigate risks for CLABSI development in patients. Compliance of dialysis staff was measured using a CDC audit tool, developed through the CDC Dialysis Collaborative, which outlined necessary steps within five areas of dialysis: (1) connection, (2) disconnection, (3) medication preparation, (4) medication administration, and (5) hand hygiene opportunities.
Overall compliance reported for connection, disconnection, medication preparation, medication administration, and hand hygiene opportunities were 59%, 47%, 0%, 100%, and 94%, respectively. Once the overall compliance was broken down further, the team identified areas in each category needing improvement. Steps such as “catheter hub scrub/dry time” were inconsistent, having a designated area of medication preparation, and aseptic technique were observed to have reduced compliance. To improve these areas, the team recommended several strategies including the standardization of catheter hub “scrub” and drying times, initiating sterility for the entire process, and establishing a designated medication preparation counter within the unit. This method of auditing and providing feedback can be replicated in other dialysis settings of healthcare facilities to maintain or improve compliance. This careful attention to proper maintenance may help reduce risks of developing healthcare associated infections, and in turn, reduce costs associated with extra hospitalizations and care from these infections.


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Item Type: Other Thesis, Dissertation, or Long Paper (Master Essay)
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Czernikowski, Daradmc163@pitt.eddmc1630009-0007-2718-9877
ContributionContributors NameEmailPitt UsernameORCID
Committee ChairMontoya, Lindsaylindsay.montoya@chp.eduUNSPECIFIEDUNSPECIFIED
Committee Co-ChairMartinson, Jeremyjmartins@pitt.edujmartinsUNSPECIFIED
Date: 17 May 2023
Date Type: Completion
Submission Date: 20 April 2023
Access Restriction: No restriction; Release the ETD for access worldwide immediately.
Number of Pages: 42
Institution: University of Pittsburgh
Schools and Programs: School of Public Health > Infectious Diseases and Microbiology
Degree: MPH - Master of Public Health
Thesis Type: Master Essay
Refereed: Yes
Uncontrolled Keywords: Hemodialysis, Central line associated bloodstream infections, Compliance, Hospital Acquired Infections
Date Deposited: 17 May 2023 17:21
Last Modified: 17 May 2023 17:21


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