Preventing Bloodstream Infections in Outpatient Hemodialysis Patients

Preventing Bloodstream Infections in Outpatient Hemodialysis Patients


Hello. My name is Dr. John Jernigan
and I’m a medical officer at the Centers for Disease
Control and Prevention or CDC. Infections are the second
leading cause of death among hemodialysis patients and many of these infections
are preventable. The following video segments
will review recommended practices based on published
evidence and best practices that you can use to help
prevent infections and keep your patients safe. Hand hygiene is one of the
most important ways to prevent the spread of infections. Hand hygiene means either
washing your hands with soap and water or using an
alcohol-based hand rub. When your hands are
contaminated with blood, other body fluids,
or are visibly dirty, wash them with soap and water. If your hands are not
visibly dirty, you can use an alcohol-based
hand rub instead. There are many times when it
is necessary for you to perform hand hygiene, including: Before and after you
provide care for a patient Before you draw, inject, or
infuse a medication or solution Before you cannulate a fistula
or graft or access a catheter After you touch blood, body
fluids, mucous membranes, or used materials such as
dressings or spent dialysate After you touch medical
equipment or other items at the dialysis station and ·
After you remove your gloves Changing your gloves is
important to protect your patients from infections. Examples of when you should
remove your gloves and put on new gloves include: After contacting a
potentially contaminated site before moving to a clean site After contact with
blood or body fluids and After completing tasks
at one patient station and moving to another station Remember, two easy ways
to reduce the chances of spreading an infection are
to perform hand hygiene and change your gloves. Safely handling and caring
for a patient’s vascular access is vital for
preventing infections, particularly in patients
who use a catheter, because the risk of infection is
highest in these patients. This segment will teach you ways
to follow aseptic technique, which means taking great
care not to contaminate the catheter during connection
or disconnection procedures. It is also important to
follow aseptic technique while caring for the catheter
exit site, which includes the following steps: While wearing other appropriate
personal protective equipment, or PPE, perform hand
hygiene and put on a new, clean pair of gloves. Remove the catheter dressing. Evaluate the catheter
exit site for signs of infection-like
redness or swelling. Remove your gloves,
perform hand hygiene, and put on a new,
clean pair of gloves. Apply chlorhexidine to the
exit site using mild friction. Let the exit site air dry
naturally and do not touch it. Apply an antimicrobial
ointment that is compatible with the catheter material. Apply clean dressing to
the exit site; be careful not to touch
the exit site. And remove your gloves
and perform hand hygiene. To properly perform a
catheter “scrub-the-hub” procedure during connection,
use the following steps: Put on a gown and a face shield. Use a mask if required
by facility policy. Perform hand hygiene and put
on a new, clean pair of gloves. Some centers may choose
to use sterile gloves. Make sure to clamp both
limbs of the catheter to prevent an air embolus. Remove the caps. While keeping the
catheter clamped, apply antiseptic to each
end of the catheter, which are the “hubs,”
using a new, sterile antiseptic pad for each hub. Scrub the end and sides of
each hub with friction, ensuring that all
debris is removed. To maintain aseptic
technique, let the catheter limbs and hubs
air dry naturally. Do not touch the cleaned hubs,
and do not set the hubs down. Connect the catheter to
the blood lines using aseptic technique;
unclamp the catheter only after it is connected. And remove your gloves
and perform hand hygiene. If any of your patients use
a needleless connector device on their catheter,
you should follow the manufacturer’s recommendations
for that type of device. When the patient has
completed treatment, the same care should
be taken using the “scrub-the-hub” procedure
for catheter disconnection. While wearing other appropriate
PPE, perform hand hygiene and put on a new,
clean pair of gloves. Make sure to clamp the
catheter and then disconnect the catheter from the blood
lines using aseptic technique. Once again, apply
antiseptic to the ends-or “hubs”-of each catheter. Use a new, sterile
antiseptic pad for each hub. Scrub the end and sides of
each hub with friction, ensuring that all
debris is removed. Let the catheter limbs and
hubs air dry naturally. Do not touch the cleaned hubs,
and do not set the hubs down. Attach new sterile caps
using aseptic technique. And remove your gloves
and perform hand hygiene. You should “scrub-the-hub”
anytime there is a line disconnection or reversal. Following the “scrub-the-hub”
protocol and paying close attention to aseptic
technique will help prevent bloodstream infections. Safely handling or caring for
a patient’s vascular access is important to prevent infections. This segment will teach you ways
to follow aseptic technique, which means taking great
care to not contaminate the fistula or graft site during cannulation and decannulation. This video segment does
not apply to patients who use buttonhole access. Here is how to perform the
cannulation procedure for patients with
fistulas or grafts: Patients are encouraged
to wash their own access site if possible. Clean the site with soap
and water if the patient hasn’t already done so. Put on a gown
and a face shield. Perform hand hygiene and put
on a new, clean pair of gloves. Assess the vascular access
site for signs of infection such as redness or swelling. If there are signs of infection, do not cannulate without
further investigation. If the site is clear,
apply skin antiseptic to the site and
allow it to dry. To maintain aseptic technique,
let the antiseptic air dry naturally and do not
touch the cleaned site. Perform cannulation
and be careful not to contaminate the area
that has been cleansed. Secure the needles and
connect to the blood lines using aseptic technique. And remove gloves and
perform hand hygiene. When the patient has
completed treatment, here are the steps for fistula
or graft decannulation: Put on a gown and a face shield. Assist the patient with
gloving if they will be compressing their
access site. Perform hand hygiene and put
on a new, clean pair of gloves. Disconnect from the blood
lines using aseptic technique. Activate the needle
retraction device and remove needles using
aseptic technique. Dispose of the needles in
a proper sharps container. Apply clean gauze or a
bandage to the access site and compress it with
clean, gloved hands. Both the staff and patient
should remove gloves and perform hand hygiene. Following these steps
will reduce the risk of an access-related infection. Dialysis staff must perform
routine disinfection of the dialysis station to prevent
the spread of infections. The following steps are intended
to be used when there is no visible blood on surfaces
at the dialysis station. When blood or other soil
is visible, surfaces must be cleaned prior to disinfection. Here are the actions you
should take before beginning routine disinfection
of the dialysis station. While wearing a gown and
gloves, disconnect and take down the used blood
tubing and dialyzer from the dialysis machine. Discard tubing and dialyzers
in a leak-proof container, or remove dialyzer from the
station in a leak-proof manner. And check for visible
soil or blood on surfaces. All visible blood should
be cleaned immediately. The following actions may
be performed in any order: Ensure that the priming
bucket has been emptied. Discard all single-use supplies. Move any reusable supplies
to an area where they will be disinfected before being
stored or returned to a dialysis station. Ensure that the patient
has left the dialysis station. Finally, remove your gloves
and perform hand hygiene. Now here are the steps for
routine disinfection of the empty dialysis station
when there is no visible soil or blood on surfaces: While wearing a gown,
put on clean gloves. Apply disinfectant
to all surfaces in the dialysis station using
a firm wiping motion. Make sure that surfaces
of the station are visibly wet with disinfectant. Also disinfect all surfaces
of the emptied priming bucket. Let all surfaces
air dry naturally. Avoid recontaminating
surfaces by keeping any used or potentially contaminated
items away from the disinfected surfaces. Finally, remove your gloves
and perform hand hygiene. Do not bring the next patient
or any supplies for the next treatment to the dialysis station until all of these steps have been completed. Following these steps for
routine disinfection will help prevent the
spread of infections.

6 thoughts on “Preventing Bloodstream Infections in Outpatient Hemodialysis Patients”

  1. I do not think that "scrub the hub" is safe to do in a typical dialysis unit. The potential to contaminate the CVC is huge, especially when using an alcohol pad as shown in the video.

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