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Management research to provide operational advice on improving quality, reducing costs and eliminating disparities.

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National Opportunity to Improve Infection Control in ESRD

Despite advances in dialysis-related technology and documented improvements in many processes of care over the last decade, chronic dialysis patients in the U.S. continue to have poor outcomes compared to other industrialized nations. Evidence suggests that infection control guidelines are not uniformly practiced in U.S. dialysis facilities. In 2007, 12 percent of U.S. dialysis patients were hospitalized due to septicemia, and 16 percent of all deaths were attributable to an infectious cause. Many of these infections are preventable through the use of evidence-based infection control practices.

The Agency for Healthcare Research and Quality awarded a two-year contract to the HRET and its partners, the University of Michigan, Kidney Epidemiology and Cost Center, and the Renal Network of the Upper Midwest, Inc. to implement and use resources that will reduce infections in dialysis facilities. The goal of the project was to reduce vascular access infections, enhance infection control best practices among clinicians and improve safety culture using the Comprehensive Unit-based Safety Program framework.

Infection control checklists and an infection control worksheet were developed and implemented by facilities in two networks. Educational materials focused on using the CHARGE acronym, which stands for:

  • Culture of Safety
  • Hand Hygiene
  • Access Site (Preparation/Cleansing)
  • Reduce and Remove Catheters
  • Great Connection and Disconnection
  • Evaluation

The project also developed the AHRQ ESRD Toolkit, which is available for download at

If you have any additional questions or comments, please contact Kristina Davis at or (312) 422-2644.

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