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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.

New Guideline to Reduce Unexpected Disease Transmission Through Organ Transplantation

Categories: Healthcare-associated infections, Organ and Tissue Safety

Matthew J. Kuehnert, MD

Matthew J. Kuehnert, MD

Author – Matthew J. Kuehnert, MD
Director, Office of Blood, Organ, and Other Tissue Safety
CDC Division of Healthcare Quality Promotion

This week, the U.S. Department of Health and Human Services (HHS) released a new guideline to improve patient safety by reducing disease transmission through organ transplantation.  This guideline updates the 1994 U.S. Public Health Service (PHS) guideline for preventing transmission of human immunodeficiency virus (HIV) through organ transplantation, and adds guidance for reducing unexpected transmission of hepatitis B virus (HBV) and hepatitis C virus (HCV) through organ transplants. 

Disease transmission from infected donors has been reported in heart, lung, liver, kidney and pancreas recipients.  From 2008 to 2011, the Centers for Disease Control and Prevention (CDC) participated in more than 200 investigations of suspected, unexpected disease transmission through transplants.  Of these, there were 15 instances in which HIV, HBV or HCV infection was confirmed to have been transmitted from the organ donor to the recipient.

The 2013 PHS Guideline for Reducing Human Immunodeficiency Virus, Hepatitis B Virus, and Hepatitis C Virus Transmission through Organ Transplantation, published in Public Health Reports, recommends the use of more sensitive tests so that patients can be protected from infections transmitted from a transplanted organ, and be informed of risks to the greatest extent possible.

The major changes from the previous 1994 PHS guideline are:

What to tell patients when things go wrong (Part 2 of 2)

Categories: Healthcare-associated infections

Abbigail Tumpey, MPH CHES

Abbigail Tumpey, MPH CHES

Author – Abbigail Tumpey, MPH CHES
Associate Director for Communications Science
CDC, Division of Healthcare Quality Promotion

In my last blog, I discussed some of the emotions that patients may feel when they are notified that they were potentially exposed to an infectious disease during medical care – fear, anxiety, anger, loss of trust, and lack of control. Given this mix of strong emotions, how does a healthcare facility representative break the bad news to a patient?  How do you balance being transparent and with retaining the trust of your patients?  The answer is in proven risk communication concepts that ensure we address patients’ concerns and feelings, while giving them the ability to take back control of the situation (and their health and healthcare).

Risk or crisis communication literature identifies four factors that determine whether the public will perceive a messenger as trusted and credible.  To maintain trust, a healthcare facility representative must express:

  1. Empathy and caring
  2. Honesty and openness
  3. Dedication and commitment
  4. Competence and expertise

For example, a spokesperson could say, “We realize that you turn to Dr. Smith’s Medical facility to get better.  This event is intolerable to us as well, and we want to work with you to resolve the situation and ensure your safety and well-being.  We are taking steps to ensure that this event never occurs again in our facility.”  Then, the healthcare facility needs to follow through on these steps and work to prevent such incidents in the future.

What to Tell Patients When Things Go Wrong (Part 1 of 2)

Categories: Healthcare-associated infections

Couple reading a letter

Author – Abbigail Tumpey, MPH CHES
Associate Director for Communications Science
CDC, Division of Healthcare Quality Promotion

Imagine this – the phone rings, you hear a voice on the other end, “Hi, Mrs. Tumpey….I’m calling from Dr. Smith’s office.  You had medical care at our facility a couple of months ago.  We are calling to inform you that during the procedure an unacceptable practice may have occurred that could have put you at risk for hepatitis or HIV infection.  Although the risk is low, we want to ask you a series of questions and request that you come in to our offices to be tested.”

What are you feeling at that moment?  Most likely, you are not really listening to what the caller is saying.  Immediately, you are thinking, “How could this happen to me?”  You are probably overwhelmed with a mix of emotions – fear, anger, sadness, and anxiety.  This is similar to the type of phone call or letter that tens of thousands of patients have received in the past decade.  Last year alone, nearly 14,000 patients were notified that they may be at risk for fungal meningitis or another fungal infection after contaminated medication was sent from an individual compounding pharmacy to 23 states.  Recently, several thousand patients were notified in Oklahoma after unsafe practices occurred for many decades in a dental facility.

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