Healthcare-Associated Infections: Dialysis Events

Clinical Summary

• “Dialysis events” are standardized surveillance events reported by outpatient hemodialysis facilities through CDC’s National Healthcare Safety Network (NHSN). In Tennessee, this condition/event is reported via NHSN.
• Outpatient dialysis centers report three event types: IV antimicrobial start, positive blood culture, and pus/redness/increased swelling at the vascular access site.
• NHSN also generates measures from reported data (e.g., bloodstream infection, local access site infection, access-related bloodstream infection, and vascular access infection) to support facility and public health monitoring.
• Reporting follows NHSN protocol details (including the “21-day rule” for related events and how to record multiple event types occurring together on a single form when related).
• Tennessee has required outpatient dialysis facilities to report dialysis events to NHSN since 2012, supporting statewide HAI surveillance and prevention efforts.

Clinical Info & Links

What It Is

Dialysis is a treatment that removes excess fluid and wastes from the blood when the kidneys can no longer do so. Because dialysis patients often need frequent vascular access (for example, needles or a catheter into a fistula, graft, or central line), they have a higher risk for infections. In Tennessee, outpatient dialysis centers report specific “dialysis events” (such as positive blood cultures, starts of IV antibiotics, and signs of infection at the access site) to support infection prevention and public health monitoring.

Signs and Symptoms

Possible signs of infection for someone receiving dialysis can include fever or chills; feeling suddenly very ill; and redness, swelling, or pus at the vascular access site (the place where dialysis connects to the bloodstream). These symptoms can signal a serious infection and should be evaluated promptly.

How It Spreads

Germs can enter the bloodstream or tissues through the dialysis access site, especially when access is used frequently. Infections and spread are most often associated with healthcare settings, and bacteria can spread between patients via contaminated hands, surfaces, or equipment if strong infection prevention practices are not followed. CDC tracks these events through the NHSN Dialysis Component to help facilities detect problems and prevent infections.

Diagnosis and Treatment

Healthcare providers diagnose suspected dialysis-related infections using clinical evaluation and lab testing (such as blood cultures) and by examining the access site. Treatment depends on the type and severity of infection and may include antibiotics and management of the vascular access (for example, addressing an infected access site or catheter). Dialysis facilities use CDC’s NHSN Dialysis Event definitions (including IV antimicrobial starts, positive blood cultures, and access-site findings) to ensure infections are identified and acted on consistently. 

Reporting in Tennessee

Outpatient hemodialysis facilities in Tennessee are required to report dialysis events through CDC’s National Healthcare Safety Network (NHSN) as part of statewide healthcare-associated infection reporting.