Public Health

4 keys to preventing infections among patients on dialysis

Jennifer Lubell , Contributing News Writer

Quin Taylor recalls her shock when she walked into an exam room for her regular dialysis appointment one Monday and saw blood on the wall.

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It was her own blood, she realized, that splattered the wall after her needles were taken out at a previous visit. She assumed the staff would disinfect the wall between visits, but the blood was still there when she came back on Wednesday—and again on Friday for treatments.

She politely asked the technician to clean it up. “He didn’t respond the way I expected,” she said. Taylor was told to get alcohol pads and clean it up herself.

As a patient with kidney failure, Taylor underscores the importance of keeping dialysis centers clean and disinfected. “You’re coming in contact with a lot of bacteria and germs, open blood.” The parts that need to be cleaned most are machines, chairs, countertops—anything the patient encounters, she said.

This personal story and others are featured in a new four-part CME series that seeks to educate nephrologists and other health professionals about infection control in outpatient dialysis facilities. The goal is to protect workers and their patients from preventable infections. 

The AMA released this CME series in conjunction with the American Society of Nephrology (ASN) and the Centers for Disease Control and Prevention (CDC)’s Project Firstline.

Infection is one of the top two causes of hospitalization and death among patients on dialysis. These patients are at such a high risk of infection because dialysis “requires frequent access to the bloodstream using needles or catheters,” according to a recent Vital Signs report from the CDC. Also, there are inequities in patients who develop end-stage kidney disease, with prevalence four-times higher among Black patients and more than twice as high among Hispanic patients, compared with white patients. 

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Meanwhile, a disproportionately larger share of dialysis patients with “bloodstream infections lived in U.S. Census Bureau tracts with higher poverty, more household crowding and lower education levels,” says the Vital Signs report, perhaps indicating that lower socioeconomic status also is related to the risk of developing bloodstream infections.

“The AMA recognizes that everyone, especially those on the front lines of health care, has a role in preventing infections and keeping patients safe,” AMA President Jack Resneck Jr., MD, said in a statement. “We believe these modules and ongoing work with the national training collaborative will help prevent the spread of avoidable infections and improve health outcomes for our patients.” 

The interactive AMA Ed Hub™ CME modules cover common infection-control mistakes that health personnel make and how to improve practices in these four key areas of outpatient dialysis infection prevention:

The module on environmental cleaning and disinfection, for example, discusses high-touch surfaces, the potential for germs and infections, and outlines best practices.

A few moments’ cleaning and disinfecting surfaces and equipment can prevent germ spread, says the module.

Staff should use a low-level disinfectant, or an EPA-registered hospital disinfectant, to clean environmental surfaces. The module explains the importance of reading labels and following instructions for proper dilution, application, wet contact, and dry times.

The module also addresses common disinfection mistakes. “Blood in the environment is great food for bacteria,” the CME module says.

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Mistakes can happen if surfaces and devices aren’t disinfected regularly between patients. Other common errors include not waiting for the patient to leave the station before disinfecting and failing to discard single-use supplies.

Staffers don’t always empty and disinfect priming buckets or allow surfaces to dry before using them. They can fail to clean their hands after disinfecting surfaces. They might lean on surfaces with dirty PPE or set PPE in clean areas.

The module stresses that health care personnel must avoid distractions such as phone calls when doing environmental cleaning. Even momentary distractions can result in infection-spreading errors such as using surfaces that aren’t yet dry after disinfection or that haven’t yet been cleaned.

Prevention means recognizing germ reservoirs, considering workflow and setup, focusing on personal habits and creating a culture of infection control, the module says. This means wiping down medication prep areas regularly, staying informed about disinfectant instructions for use, knowing what PPE to wear, and how to clean up blood spills.

All facilities should have a procedure in place that specifies which surfaces to disinfect, what disinfectant to use and who is responsible for surface disinfection and the frequency.