HISWA Haemodialysis Access-associated Bloodstream Infection Surveillance Denominator Data (pt-months) Collection Tool (Incentre)

No. of patients No. of patients No. of pt’s No. of patients with a non-cuffed Month with a cuffed (tunnelled) with an AV Graft with an AV Fistula (non-tunnelled) catheter catheter e.g. Hickman (native & synthetic) e.g. Vascath Day/Date Shift 1 Shift 2 Shift 3 Shift 1 Shift 2 Shift 3 Shift 1 Shift 2 Shift 3 Shift 1 Shift 2 Shift 3

Monday Date

Tuesday Not applicable Date Totals for each shift / Add Mon & Tues for each shift a b c a b c a b c Access device total for Record 2 non-cuffed catheter Total no. of cuffed catheter Total no. of AVF Total no. of AVG month (Add all shift pt-months on HISWA database pt-months = (a+b+c) pt-months = (a+b+c) pt-months = (a+b+c) totals)

DENOMINATOR DATA COLLECTION INSTRUCTIONS

. Count the number of patients with cuffed catheters, AVF and AVG on the first Monday and Tuesday of each month. Refer also to “Key Dates” on the HAIU website. . Count one vascular access type for each patient only once for the month. . If the patient has multiple access devices, count the device with the highest risk of infection (Note: this may not be the device currently in use). Cuffed catheters have the highest risk of infection and AVF the lowest. . Record 2 non-cuffed catheter pt-months every month. BSIs associated with non-cuffed catheters will be entered on HISWA database as per usual.

INCLUSIONS AND EXCLUSIONS

. Count chronic haemodialysis patients only - exclude those with acute renal failure. . Count visitors from other WA dialysis units attending the incentre on the collection dates. . Do not count short term (<1 week) visitors from outside WA.

Jan 2015