Dialysis Infection Risks and Prevention Strategies: A Q&A With NP Leader Octavia “Tavi” Schlueter, MSN, RN, CPNP-PC, PMHS

Dialysis settings pose a unique and complex infection prevention challenge. Patients often require frequent vascular access, prolonged exposure to health care environments, and ongoing invasive procedures, all while facing varying degrees of immunocompromise. For infection prevention and control (IPC) teams, balancing high patient volume with strict adherence to evidence-based practices is critical to reducing harm.

Octavia “Tavi” Schlueter, MSN, RN, CPNP-PC, PMHS, brings both clinical and operational expertise to this discussion. A dual-certified nurse practitioner in pediatrics and pediatric mental health, Schlueter has led interdisciplinary inpatient teams, mentored advanced practice clinicians, and overseen quality initiatives in complex care settings. She now serves as strategic partnership and growth manager at Collaborating Docs, where she helps nurse practitioners and physician assistants build compliant, effective collaborations nationwide.

In this Q&A with Infection Control Today® (ICT®), Schlueter discusses the most significant infection risks in dialysis settings, the critical role of vascular access management, and how IPC teams can better support frontline staff through ongoing education and culture change. Her insights emphasize that effective infection prevention in dialysis is not about one-time training, but about embedding safety into daily practice, leadership priorities, and team accountability.

ICT: What are the general infection risks in the dialysis setting?

Octavia “Tavi” Schlueter, MSN, RN, CPNP-PC, PMHS: Dialysis patients face a uniquely high infection risk due to a combination of immunocompromise, frequent vascular access, and repeated exposure to health care environments. The most significant risks include bloodstream infections, particularly related to central venous catheters, as well as local access site infections, hepatitis B and C transmission, and antimicrobial-resistant organisms such as MRSA.

Environmental factors also play a role. Dialysis units manage high patient throughput, shared equipment, and close patient proximity, which increases the risk of cross-contamination if strict cleaning, disinfection, and hand hygiene protocols are not consistently followed. Even small lapses in aseptic technique can have serious consequences in this population.

ICT: How can an IPC team better support staff on dialysis education as it relates to infection prevention and education?

OS: IPC teams are most effective when education is continuous, practical, and embedded into daily workflows rather than treated as a one-time training event. This includes:

1. Regular hands-on refreshers on vascular access care, aseptic technique, and personal protective equipment use
2. Clear, standardized protocols that are easy to reference in real time
3. Just-in-time training when new staff onboard or when process changes occur
4. Visual cues and checklists at points of care to reinforce best practices

It’s also critical to foster a nonpunitive culture around safety. Staff should feel empowered to speak up about breaches or near misses without fear of blame. When teams view infection prevention as a shared responsibility rather than a compliance burden, adherence improves significantly.

ICT: How is vascular access handled, and what are the best practices?

OS: Vascular access is one of the most important—and highest-risk—aspects of dialysis care. Best practices include:

• Prioritizing arteriovenous (AV) fistulas and grafts over central venous catheters whenever clinically feasible, as catheters carry the highest infection risk
• Strict adherence to aseptic technique during cannulation, connection, and disconnection
• Thorough skin antisepsis using appropriate agents (eg, chlorhexidine) before access
• Routine inspection of access sites for signs of infection such as redness, warmth, swelling, or drainage
• Prompt removal of central venous catheters when no longer medically necessary

Consistent documentation and early intervention when abnormalities are detected are key to preventing minor issues from escalating into serious infections.

ICT: How do you handle high patient volume and maintain IPC standards?

OS: High patient volume increases pressure on staff and systems, but it should never compromise infection prevention standards. The most successful dialysis units address this by:

• Standardizing workflows so IPC steps are built into routine care rather than treated as add-ons
• Ensuring adequate staffing ratios and realistic scheduling to reduce time pressure
• Using dedicated equipment where possible, and enforcing strict cleaning protocols for shared devices
• Conducting periodic audits and real-time feedback to reinforce adherence
• Leveraging team-based accountability, where everyone from clinicians to support staff shares responsibility for IPC adherence

Ultimately, maintaining IPC standards in high-volume settings requires leadership buy-in, operational discipline, and a culture that prioritizes patient safety over speed.