Enhancing Dialysis Safety: Voices from the Making Dialysis Safer Coalition

Some answers have been edited for clarity.

In June 2023, The Making Dialysis Safer (MDS) for Patients Coalition convened representatives from public health departments and dialysis settings to talk about infection prevention and patient safety in dialysis.

ASTHO had the opportunity to talk with a few attendees and ask them questions about the role of public health in dialysis safety and the impact the MDS coalition has had on their work.

Why is it important for public health to be involved in conversations regarding patient safety in dialysis settings?

DENISE PARR:
It's important to have public health involved in dialysis because it's a very complex realm and process—you have both hemodialysis and peritoneal dialysis. Both have so many different steps; all it takes is one little spot, and there's that opportunity for an infection to occur. And so, we at the Michigan Department of Health and Human Services strive to ensure that we are removing barriers to access and reducing disparities of health among our residents in Michigan. This is one area where I feel we can make a difference by teaming up with our network coordination providers, facilities, and Centers for Medicare & Medicaid Services. With all of us working together, I think we can move the needle in a positive direction to reduce bloodstream infections.

What does your health department do to promote patient safety in dialysis settings?

KATE TYNER:
In Nebraska, for healthcare-acquired infections (HAI) support, our program offers many different types of services. The most apparent type of service offered is if there's an outbreak of infections, that would be the highest tier of a need for involvement. For instance, that outbreak could be something like we have four COVID-19 cases that appear to be related to a dialysis center. Or, harder to see but very important is when patients have a very resistant type of organism, and maybe we would find that that patient had care in an acute care hospital, but they also dialyze in an in-center place. And so, in those ways, even if it's not an organism that that healthcare team in the dialysis center would see, we would need to be involved to ensure that other patients and staff in those centers were safe. So that's outbreak support; that's the biggest, clearest umbrella.

We also help facilities with the prevention of infection. Many health departments are staffed with people like me, who have a lot of experience preventing HAIs. I've been doing this type of work for over 15 years. For example, I have a lot of experience in bloodstream access, understanding the type of chemicals we use to disinfect the skin and the order of tasks we use to ensure that those pieces of equipment or the skin are kept as clean and aseptic as possible. Because I've lived a long time in that world, I can absolutely go into a dialysis center, just like I can go into an acute care facility and say, Hey, maybe this would make your job a little more effective or a little simpler. I am not asking for extra steps, not asking you for extra things. I can use some of my experience and another type of healthcare and say, How can we make this job easier for you? You're being really efficient right now; how can I help you be mindful of this important task in the middle and understand why it's important? So, that's outbreaks, prevention-based visits, and education.

I think many people in the dialysis community don't necessarily know what HAI teams are doing and available to do. One thing we like to do from a HAI perspective is offer education. My team in Nebraska has been working hard for years to try to bring great education to people at a low price. And so, in many cases, that's free. I can get you continuing nursing education credits so you can keep your license. If it's difficult for you at a dialysis community to come up with how to train dialysis technicians on hand hygiene, for example, I've been doing that for years, and I would love to help you with that, and it doesn't cost anything. When you're working from an HAI program perspective, that's your tax dollars at work.

Why do you participate in the Making Dialysis Safer Coalition?

ERIC TAKIGUCHI:
Our team recently joined the coalition last year. We received many consultation resources for infection control practices, which subsequently allowed us to become better partners with the dialysis facilities serving Los Angeles County.

TYNER:
The MDS coalition provides a unified voice in the dialysis community. CDC lends an important and trusted name to infection control methodology. And so, with the MDS coalition materials, when CDC says that these things matter, providers know it's trusted, worthwhile, and practical information that should be implemented. In that way, the MDS coalition materials have made those standards available and unified between facilities. We know that bigger corporations sometimes have even more materials. However, especially for our independent facilities, it's important that they can access trustworthy, evidence-based, practical infection prevention materials that do not cost. In those ways, the MDS coalition is really helping.

PARR:
Being a part of the MDS coalition is vital. I was actually a member in the acute care setting side. There's not a lot of infection prevention dialysis training in our certification for infection control exam. We're finding that as we have these new infection preventionists coming in, they're novices and unsure where to start in those dialysis centers. I used to use the MDS checklists all the time to start conversations with the people doing the dialysis, whether it's that staff or a vendor coming in. I also encourage them also to join a coalition because together, we can all start collaborating in a positive way.