Infection Prevention and Control
Risk and prevention
Dialysis and transplant patients are immunocompromised by uremia, malnutrition, vascular access, and immunosuppressive drugs. Understand standard precautions, hand hygiene, and aseptic technique for catheter and access care. Know that catheter-related bloodstream infection is the most serious access complication and that fistula use reduces risk. Review vaccination needs and screening for bloodborne pathogens. Understand isolation precautions for multidrug-resistant organisms and the importance of antimicrobial stewardship.
Recognizing and managing infection
Identify access infection signs: redness, warmth, purulence, fever, and drainage. Recognize peritonitis in peritoneal dialysis (cloudy effluent, abdominal pain). Recognize transplant infections including cytomegalovirus and BK virus. Understand that fever in a dialysis or transplant patient requires prompt cultures and empiric therapy, often including vancomycin for suspected access infection per protocol.
Traps
Do not attribute fever in a dialysis patient to a noninfectious cause without evaluating the access. Do not assume a tunneled catheter is sterile because it is new. Do not use the access arm for routine blood draws or blood pressure. Do not skip hand hygiene before and after access manipulation. Do not assume a negative culture means no infection if antibiotics were already started.
Worked example and rule of thumb
A patient with a tunneled catheter has fever and chills during dialysis. Stop the session as needed, obtain blood cultures from peripheral and catheter sites, and notify the provider for empiric antibiotics. Rule of thumb: any fever in a dialysis or transplant patient is an access or line infection until proven otherwise, and every access manipulation begins with hand hygiene and aseptic technique.