Addressing Disparities in Hemodialysis-Associated Bloodstream Infection Rates: Insights from Focus Group Analyses

Résumé fourni par la source

Background: Bloodstream infections (BSI) cause substantial morbidity in people undergoing dialysis and the risk may vary by race, ethnicity, poverty level and educational status. Perceptions of physicians, dialysis staff, and patients/caregivers were gathered to inform the development of infection prevention education aimed at reducing disparities in BSI risk. Methods: The American Society of Nephrology convened 3 virtual focus groups (physicians, n=5: dialysis nurses and technicians, n=7) and patients/caregivers (n=5). The 1.5-hour sessions were recorded, transcribed, and systematically analyzed and coded by 3 independent reviewers to identify major themes. Results: Six major themes were identified. Participants consistently mentioned that unstable housing, overcrowded living environments, and limited access to hygiene facilities increase vulnerability to infection. Patient-specific concerns, such as fear of pain, anxiety about needles, and cosmetic issues related to arteriovenous access, were noted as reasons some individuals may prolong catheter use despite known infection risks. Systemic barriers, including inconsistent staff training, staff burnout, and variable access to resources, hinder effective infection prevention within dialysis units. Focus groups noted that effective infection prevention education must be language- and health literacy- concordant, aligned with each patient’s learning preferences, and timed to match individual readiness and needs. Building trust and maintaining open communication between patients and care teams were viewed as essential strategies to reduce BSI risk. Notably, empowering patients to speak up when they observe infection prevention breaches and actively participate in their own care was highlighted by the patient/caregiver and dialysis staff focus groups, but not by physicians as a strategy to reduce BSIs. Conclusion: Three focus groups, each representing diverse stakeholder perspectives identified six central themes that either contribute to disparities in dialysis-associated BSI risk or offer opportunities to reduce that risk. These themes have already formed the basis for the development of infection prevention education for frontline healthcare providers and the actionable strategies identified can be utilized by dialysis units for reducing BSI in patients.

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