>> Good afternoon, everyone.
Thank you for joining the NHSN Dialysis Annual Updates Webinar.
My name is Letty Lamping.
And today, I am joined by my colleague, Susan Cali.
This afternoon, we are going to describe the changes in dosing for hepatitis-B vaccine
on the annual practice survey for outpatient and home dialysis facilities.
We are going to describe the new fields for reporting access types
on the dialysis surveillance event form, and we're going to illustrate the use of new fields
for reporting access types by providing some case scenarios.
As you may know, some hepatitis-B vaccines require two doses, some require three,
some require four doses, and as a result, these questions were updated
to say a completed series, instead of a three-dose series, as it has had in the past.
This allows us to capture all completed hepatitis-B vaccine data,
regardless of the number of doses in the series.
This change was made to questions 25 through 28, on the 2022 Outpatient Dialysis Annual Survey,
and on questions 15 through 17 on the Home Dialysis Survey.
On the dialysis event form, a new field was added to obtain the access used
on the day of the dialysis event.
This field was added, so that we could collect data on the specific access used
on the time-- at the time of the event.
This is an optional field for the 2022 reporting.
It will become a required field in 2023.
Before we go on, I want to be clear that the inclusion
of the new field does not change the expectation that all accesses that a patient has be reported
under risk factors, as you've always done in the past.
Now, in the event that more than one access was used on the day of the event,
we asked that the access, that the highest risk of infection be selected
in the access used on the day of event field.
And finally, we have made revisions to the Dialysis Event Table of Instructions,
to provide additional guidance for the new field access used on the day of event.
These documents are posted on the NHSN Dialysis website.
I will now turn this over to Susan Cali, who will go through a case scenario.
Susan?
>> Thank you, Letty.
So, today we've got one case scenario that we're going to review with a couple of questions,
and discuss the use of these new fields.
So you have a 65-year-old female who presented on January 19, 2022,
to the Dialysis Clinic for hemodialysis.
The patient had a new fistula, and was receiving dialysis via tunnel dialysis catheter.
During the middle of her dialysis, her blood pressure dropped.
A short time later, she developed a fever.
Blood cultures were drawn, and she was given a dose of Vancomycin.
She was admitted, she was able to complete her dialysis, but was still having chills.
The clinical manager called 911, and the patient was transported
to the local emergency department.
Two days later, the clinic received results from the blood cultures,
and they were positive for Enterobacter aerogenes.
So, our first question is which facility would report the positive blood culture,
or BSI, to NHSN?
A, the hospital, B, the dialysis clinic, C, both the hospital and dialysis clinic, or D,
neither the hospital or the dialysis clinic.
And the answer to this will be B, the dialysis clinic.
The dialysis clinic would report the event, since the positive blood culture occurred
in the dialysis facility prior to the patient being transported to the hospital.
Our next question is according to the dialysis event protocol,
what would be included in the event reporting?
A, the positive blood culture, B, the IV anti-microbial start, C, both the blood culture
and IV antimicrobial start would be reported by the dialysis facility, or D,
the hospital would report the positive blood culture,
but the clinic would report the IV antimicrobial start.
And the answer to this question is C, both the blood culture
and the IV antimicrobial start would be reported by the dialysis facility.
So, both the blood culture and the IV antimicrobial start would be reported
by the dialysis facility since the blood culture was collected in the dialysis facility
and the IV antimicrobial was given prior to the patient being transferred to the hospital.
Our next question.
Since the dialysis facility would be reporting the positive blood culture,
and the IV antimicrobial start, they will be reported as two separate events.
A, is true.
B, is false.
And the answer is false.
Following the guidance in the Dialysis Event Surveillance Protocol, a positive blood culture
and the IV antimicrobial start should be reported as one event,
since they occur on the same day, and are related to the same event.
And our final question, when completing the dialysis event reporting
and the NHSN application, which access would be reported using the new reporting field?
A, the tunnel dialysis catheter.
B, the fistula.
C, both the tunnel dialysis catheter and the fistula, or D,
neither the tunnel dialysis catheter or fistula,
since the dialysis clinic does not need to report the event.
And the answer to this one is going to be A, the tunnel dialysis catheter.
In the case scenario, the access used
for the dialysis treatment was a tunnel dialysis central line.
If the fistula and tunnel line was used during the event,
you would still report the tunnel central line, since it has the highest risk of infection.
That concludes our questions and our case scenarios.
We will now open the floor for additional questions.
Thank you so much for attending our annual webinar for annual updates.