Dialysis Prevention Process Measures

• Prevention Process Measures in Outpatient Dialysis Facilities Training May 2014 pdf icon[PDF – 784K]

• Dialysis Prevention Process Measures (PPM) Protocol. February 2016 pdf icon[PDF – 194K]

Audit Tools

• Hemodialysis Catheter Connection & Disconnection Observations pdf icon[PDF – 188 KB]
• Hemodialysis Catheter Exit Site Care Observations pdf icon[PDF – 254 KB]
• Arteriovenous Fistula & Graft Cannulation and Decannulation Observations pdf icon[PDF – 384 KB]
• Hemodialysis Hand Hygiene Observations pdf icon[PDF – 147 KB]
• Dialysis Station Routine Disinfection Observations pdf icon[PDF – 274 KB]
• Injection Safety Medication Preparation & Administration Observations pdf icon[PDF – 273 KB]

All Data Collection Forms are Print-only

Survey

• 57.500 Outpatient Dialysis Center Practices Survey Form January 2020 pdf icon[PDF – 250 KB]

Reporting Plan

• 57.501 Dialysis Component Monthly Reporting Plan form January 2020 pdf icon[PDF – 100 KB]
  • Customizable form word icon[DOCX – 80 KB]

Summary Form

• 57.504 Dialysis Prevention Process Measure Summary Form January 2020 pdf icon[PDF – 100 KB]
  • Customizable form word icon[DOCX – 80 KB]

• WHO 5 Moments for Hand Hygiene in Hemodialysis poster pdf icon[PDF – 890 KB]external icon
• CDC Hand Hygiene in Healthcare Settings Resources
• Prevention Process Measures Adherence Report pdf icon[PDF – 250 KB]
• Other Dialysis Prevention Process Measure Tools
• Changing a CCN within NHSN (updated July 2015) pdf icon[PDF – 290K]
• Hemodialysis Injection Safety: Medication Preparation & Administration Observations pdf icon[PDF – 370 KB]