Tip:
Highlight text to annotate it
X
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 ยท 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.