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Time for change? Lessons from a trial of the Dialysis Station Routine Disinfection Checklist

Categories: Dialysis, Healthcare-associated infections

Peggy Bushey RN, CDN

Peggy Bushey RN, CDN

Authors – Peggy Bushey RN, CDN, Renal Services
Linda Fosher, RN, Renal Services
Sally Hess MPH, CIC, Infection Prevention
Fletcher Allen Health Care, Burlington Vermont

The risk of transmitting bloodborne pathogens, including hepatitis C virus, in a hemodialysis unit can be high due to environmental contamination with blood.

Our clinic recently participated in a “test of change” utilizing a new Dialysis Station Routine Disinfection Checklist developed by CDC and their Dialysis Collaborative in hopes of decreasing the potential for cross-contamination and recommending a “best practice.”

The St. Albans clinic is a free standing, 9-station hemodialysis unit staffed by registered nurses and technicians. We are one of six satellites affiliated with Fletcher Allen Health Care, an academic, not-for-profit medical center in the state of Vermont.

We reviewed the proposed Dialysis Station Routine Disinfection Checklist noting that the major difference from our current practice was discharging the patient from the treatment station before performing terminal station disinfection. Staff agreed to a one week trial of the new checklist, if only to prove that this “waiting for the patient to leave the station” was not truly feasible.

Initially, the change in workflow was challenging. Staff felt time was wasted waiting for the patient to leave the station before starting to disinfect it. Patient turnover was extended by 10-15 minutes with an overall increase of approximately 20-30 minutes for the day. If patients required prolonged post-treatment care, they were moved out of the station and into a holding area.

Proper Environmental Disinfection: A Basic Patient Safety Expectation

Categories: Dialysis, Healthcare-associated infections

Priti R. Patel, MD, MPH

Priti R. Patel, MD, MPH

Author – Priti Patel, MD, MPH
CDC, Division of Healthcare Quality Promotion

Imagine walking into an operating room and seeing staff disinfect the room and open up sterile equipment for the next surgery while a patient is still on the table completing their procedure. Most of us would find this strange and unacceptable. Yet it happens every day in dialysis centers across the country, where it has become the norm to clean dialysis stations and set up machines for the next patient while a patient is still sitting in the chair completing their treatment. The staff who clean up the area are doing so while they are also helping a patient finish dialysis treatment, a time when patients can bleed for some time before they are ready to go home.

It’s not hard to see how this kind of multitasking for efficiency can lead to cross contamination (i.e., contamination of one patient’s medical supplies with blood or organisms from another patient). Such practices have been identified by CDC as dangerous and potentially contribute to outbreaks. Anecdotally, we have heard from dialysis center staff that the pressure they feel to get patients in and out of the stations quickly can interfere with more than just their ability to properly clean the stations. In some instances, proper hand hygiene and even medication preparation practices can suffer when they are under such intense time constraints.

Making Dialysis Safer: Simple tools to protect patients from bloodstream infections

Categories: Dialysis

Priti R. Patel, MD, MPH

Priti R. Patel, MD, MPH

Author: Priti Patel, MD MPH
Medical Officer
CDC’s Division of Healthcare Quality Promotion

While undergoing dialysis, patients have a lot on their minds. The last thing they need to worry about is getting a bloodstream infection in the process.

In the United States, more than 370,000 people receive long-term hemodialysis. Infection is a leading cause of illness and is the second leading cause of death in these patients.  Bloodstream infections are one of the most serious types of infections dialysis patients can get.  Since 1993, there has been a 40 percent increase in the rates of hospitalizations for bloodstream infection among hemodialysis patients, underscoring the importance of protecting this population.

In 2009, CDC established the CDC Dialysis Bloodstream Infection  Prevention Collaborative, a partnership of freestanding and hospital-based outpatient dialysis facilities from across the country.  These early adopters have seen great success in preventing bloodstream infections among their patients.  Collaborative participants have demonstrated a 31 percent decrease in bloodstream infections and a 53 percent decrease in access-related bloodstream infections when CDC prevention guidelines are implemented.

A Checklist for Dialysis

Categories: Dialysis

Staff volunteers demonstrate the use of scrub-the-hub protocol checklist

Staff volunteers demonstrate the use of scrub-the-hub protocol checklist

Guest Author – Gemma Downham, MPH
Infection Prevention Epidemiologist,
AtlantiCare Regional Medical Center

We have all heard about the heroic feat of
Captain “Sully” Sullenberger when he performed
an emergency landing of a passenger jet on the Hudson River in 2009. It was amazing that no
lives were lost during that potentially disastrous situation. Checklists, which have been used for decades in the airline industry, were said to have helped Captain Sully and his co-pilot run through tasks to attempt to restart the engines—and when all else failed, perform an emergency landing.

Dr. Atul Gawande, professor of surgery at Harvard Medical School and bestselling author, has advocated in his book, The Checklist Manifesto, for the use of checklists in medicine to improve patient outcomes in surgery, prevent infections, etc., by reducing the potential for human error. So, when one of the nurses in our dialysis unit asked for a checklist for putting catheterized patients on and off the dialysis machines, I was both delighted (and overwhelmed.) Where to start?

Infections in ICUs Plummeting, Too Many Remain in Hospitals and Dialysis Clinics

Categories: Antimicrobial Resistance, BSIs, CLABSI, Dialysis, Gram negatives, Healthcare-associated infections, MRSA, NHSN

Arjun Srinivasan, MD

Arjun Srinivasan, MD

Author – Arjun Srinivasan, MD
CDC’s Division of Healthcare Quality Promotion

As you know, bloodstream infections in patients with central lines can be deadly, killing as many as 1 in 4 patients who gets them. The newest edition of the CDC Vital Signs reports a major decrease in central-line associated bloodstream infections (CLABSIs) in intensive care unit (ICU) patients. This is an important triumph for patient safety and brings me a renewed sense of hope toward the elimination of HAIs. It also solidifies an expectation that infection prevention should be a priority in order to improve the safety of patients.

While progress is promising, about 60,000 bloodstream infections in patients with central lines still occurred outside of ICUs and in dialysis centers, according to our report. Much of this is preventable harm. We have to make every effort to ensure patients are protected in all healthcare facilities, all the time. So, how do we do that?
The good news is that everyone can contribute to preventing CLABSIs, no matter where the patient receives care.

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