Abstract: SA-PO965
A New Initiative to Measure the Provincial Rate of Catheter-Related Bacteremia in Ontario
Session Information
- Dialysis: Vascular Access - II
October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 704 Dialysis: Vascular Access
Authors
- Nesrallah, Gihad E., University of Toronto, Toronto, Ontario, Canada
- Yeung, Angie, Cancer Care Ontario, Toronto, Ontario, Canada
- Graham, Janet Lynn, The Ottawa Hospital, Ottawa, Ontario, Canada
- Ip, Jane, Cancer Care Ontario, Toronto, Ontario, Canada
- Patel, Monisha, Ontario Renal Network, Toronto, Ontario, Canada
- McFarlane, Philip, St. Michael's Hospital, Toronto, Ontario, Canada
Background
The use of a Central Venous Catheter (CVC) is associated with high morbidity and mortality, in part due to increased risk of catheter-related bacteremia (CRB). Patients using a CVC have a greater risk of infection and sepsis compared to patients dialyzing using an arteriovenous access. In 2016, the Ontario Renal Network (which funds dialysis in Ontario) launched a provincial quality improvement (QI) initiative with the aim to shift from local monitoring of CRB rates to a province-wide standardized tracking system. The initiative was launched with the objectives of: 1) Defining a provincial average rate of CRB, and an individualized rate for each of the Regional Renal Programs (RRP); and 2) sharing provincial data and developing program-level QI plans to help minimize CRB risk.
Methods
All 26 RRPs in Ontario collected and reported data from May 2016 – December 2017 using a tracking tool incorporating indicator methodology developed by an expert panel. Reported CRB events formed the numerator for the rate calculation, while the denominator was derived from the Ontario Renal Reporting System database (ORRS) to calculate person-time with a hemodialysis catheter. The CRB rate is expressed as infections per 1000 patient days, combining patient-time from all in-centre chronic dialysis patients at each RRP.
Results
Over a period of 20 months (May 2016 to December 2017), 696 unique CRB cases were reported over a total of 3,096,046 patient days (approximately 8482 annualized patients). Program-level CRB rates ranged from 0.09 – 0.56 and the provincial average was 0.22 episodes/1000 catheter-days. Quarterly reports were shared with the programs for data validation, comparison and monitoring purposes. The initiative enabled consistent measurement and reporting of CRB, allowed programs to benchmark themselves against their peers, and design local plans for improvement.
Conclusion
The risk of CRB is deemed to be relatively low in Ontario. This initiative has produced a sustainable system of data collection for monitoring the risk of CRB. This initiative is part of a larger strategy to ensure that all patients receiving dialysis therapy experience as few complications regardless of the type of access they have.
Funding
- Government Support - Non-U.S.