Effectiveness of Infection Control Practices in Reducing Vascular Access–Related Infections in Hemodialysis Patients: A Systematic Review

Abstract

Vascular access infections (VAIs) are a major and preventable complication among hemodialysis patients, leading to high rates of morbidity, mortality and health care costs worldwide. This systematic review explores the role of infection control measures for the prevention of VAIs in hemodialysis patients, focusing on catheter-related bloodstream infection (CRBSI) and exit-site infection (ESI). We searched PubMed, CINAHL, Scopus, Web of Science and Google Scholar, resulting in 512 studies for review from 2013 to 2025. After applying inclusion and exclusion criteria, as recommended by PRISMA guidelines, 38 studies were included in the final review. The results confirm the effectiveness of comprehensive infection prevention bundles, strict adherence to hand hygiene, catheter care, and judicious prioritization of arteriovenous fistulas (AVFs) over central venous catheters (CVCs) are associated with the most significant reduction in VAI rates. Catheter bundles reduced the incidence of CRBSI by up to 66%, with AVFs posing up to seven times less risk of bacteremia than CVCs. Other factors such as antimicrobial lock solutions, chlorhexidine exit-site dressings and nurse-driven education programs were also found to be effective in infection prevention. Nurse training and audit, as well as patient empowerment, were key moderators. The review concludes with recommendations for health-care institutions in the Oman and GCC region to establish infection prevention programs, improve nursing competency, and have surveillance systems in place to enhance patient outcomes and safety regarding hemodialysis.