Ic-01-041 Infection Control in Dialysis

POLICIES AND PROCEDURES MANUAL
INFECTION CONTROL IN DIALYSIS

DOCUMENT CONTROL REVISION NO. EFFECTIVITY DATE PAGE
NO. JANUARY O1, 2019 1 of 15
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I. OBJECTIVES
1. To prevent the exposure of any Dialysis Unit patient to any infection.
2. To exercise the optimal precaution and infection control measures in the dialysis
unit.
II. SCOPE
1. HDU Staff shall adhere to standard precautions and infection control policies
/procedures in the care of patients and management of HDU equipment.
III. DEFINITION OF TERMS

1. Infection Control – is the prevention of the spread of microorganisms which lead to
infections and elimination of health care associated infection.
Hemodialysis (HD) Removal of excess fluids and waste products by

passage of blood through an artificial kidney
Effluent Something that goes out from a machine.
ICC Infection Control Committee
IV. POLICY
1. This policy and procedure describes the infection control in OHHC dialysis unit in
order to prevent and control the spread of infection in the said unit.
2. Layout shall be provided for the following:
2.1. Allow for separate room/machines for HBs Ag (+) patients.
2.2. HD station shall be at least 1 meter apart to give room for staff movement
caring for patient.
2.3. Reprocessing room for dialyzers ideally shall have a ventilated separate area and
with exhaust.
2.4. A separate area for medication preparation.
3. Water supply and air-conditioning:
3.1. HD unit water supply to the dialysis machine shall e separately filtered through
RO system and standard filtration.
3.2. Microbial monitoring of RO water shall be done every month with microbial cut-
off of 200 cfus/ml of water with three (3) sampling points namely raw water,
product tank and point of use. The bacterial limits shall be as follows:
Prepared by: Reviewed by: Conforme: Approved by:
JAN MARVIN M. PALIJO, MSN, RN GINA M. GARCIA, MD JM PALIJO MSN,RN/ R. RAYOS DEL SOL, MD NEIL ANDREW S.J. DE LUMEN, MD
CHIEF NURSING OFFICER CHAIRMAN, DEPARTMENT OF MEDICINE RZ DE LUMEN, MD PRESIDENT

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3.2.1. HPC less than 200 CFU/ml
3.2.2. Fecal Coliform less than 1.1MPN/100ml
4. Air-conditioning and humidification equipment shall be maintained regularly to avoid

multiplication of pathogens.
V. PROCEDURE
1. Personnel:
1.1 Infection control barriers in the HDU include: Personal Protective
Equipment (PPE) such as gowns, gloves, masks, protective eye wear, and
water repellent gowns as needed to avoid direct contact with blood and
body fluids.
1.2 Staff is to be screened for basic hepatitis panel and have an HIV blood
test completed the first month of assignment to the HDU.
1.3 All personnel will follow hand hygiene technique in.
1.4 Personnel with infectious diseases shall abide by ICC policy.
1.5 Staff should remove contaminated attire before leaving the area
1.6 All personnel will follow aseptic technique at all times and sterile
technique when indicated.
1.7 All hemodialysis personnel must wear gloves when caring for patients or
touching the patient’s equipment at the dialysis station.
1.8 Personnel must remove gloves and perform hand hygiene between each
patient and station.
2.9 Report blood / body fluid exposure to supervisor immediately (refer to

Blood and Body Fluid Exposure (BBFE).
3. Environment:
2.1 The hemodialysis layout and design follows the International Standard.
2.2 Hemodialysis treatments performed on patients requiring Airborne

Precautions (TB) are done in separate rooms. Isolation procedures will be

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followed as outlined in Isolation Precautions: Transmission-Based

Precautions.
2.3 Transmission based precautions must be followed when dealing with

communicable diseases, e.g. contact precaution for MRSA (refer to
Methicillin-Resistant Staphylococcus Aureus).
2.4 Only personnel directly involved in the care of the patients are
permitted to enter the HDU.
2.5 All hemodialysis patients or other patients transfer from other facilities
to OHHC are required to be tested for HIV, HBV and HCV and are to be
designated dialysis machines specially dedicated for patients with
unknown HIV, HBV and HCV status until test results are available.
2.6 Patients whose laboratory test for HBsAg, anti HBs, HCV, and/or HIV
is/are negative should be re-screened every 3-6 months.
2.7 All patients susceptible to hepatitis B (negative for HBsAg and anti HBs)
are immunized with Hepatitis B vaccine.
2.8 All vaccinated personnel are tested for antibodies to evaluate response,
and all non-responders are given a second series of the HBV vaccine.
2.9 Records for hepatitis screening and immunization are kept in database
(cards, sheet or computerized) to allow a rapid evaluation of the
information.
2.10 Items taken to the dialysis stations should be disposed of, dedicated
for use only on a single patient, or cleaned and disinfected before being
taken to a common area or used on another patient.
2.11 Single dose vials should be dedicated to one patient only and
should not be re-entered.
2.12 Don’t use medication carts to transport medications to patient

stations.
2.13 Scrub the hub of (IV) tubing and medication vials prior to accessing.

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2.14 Use aseptic technique when preparing/ handling parenteral

medication/fluid.
2.15 Never use infusion supplies such as needles, syringes, flush

solutions, administration sets or IV fluids on more than one patient.
2.16 When multiple dose medication vials are used (including vials
containing diluents), prepare individual patient doses in a clean area
away from the dialysis stations and deliver separately to each patient
with adequate label. Do not carry multiple dose medication vials from
station to station.
2.17 Clean areas should be clearly designated for the preparation,

handling, and storage of medications, unused supplies and equipment’s.
Clean areas should be clearly separated from contaminated areas where
used supplies and equipment’s are handled. Do not handle and store
medications or clean supplies in the same or adjacent areas to where
used equipment’s are handled.
2.18 Adequate space (2.5 meters ) between patients, to prevent cross

contamination
3. Routine Precautions:
3.1 MRSA-Positive Patients. According to the CDC guidelines, contact
precautions must be used but does not require dedicated machine as
MRSA is not a blood-borne pathogen.
3.2 HBV-Positive Patients
3.2.1 HBV-Positive patients shall be dialyzed in a separate room
using designated machines, equipment, instruments and
supplies.
3.2.2 Hemodialysis nurses caring for HBV-positive patients should

not care for HBV susceptible patients at the same time (e.g.
during the same shift or during patient changeover).
3.2.3 Follow the CDC guidelines for Hepatitis B Vaccination for

dialysis patients, available at CDC website

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www.cdc.gov/vaccines/pubs/downloads/b_dialysis_guide.p
df. 4.
3.3 HCV-Positive Patients. According to the CDC guidelines, patients who are
anti-HCV positive (or HCV RNA positive) do not have to be isolated from
other patients or dialyzed separately on dedicated machines. A local risk
assessment should be undertaken to determine further measures that may
be necessary relating to Hepatitis (HCV) positive patients.
3.4 HIV-Positive Patients. According to the CDC guidelines, infection control

precautions recommended for all hemodialysis patients are sufficient to
prevent HIV transmission between patients. HIV-infected patients do not
have to be isolated from other patients dialyzed separately on dedicated
machines. A local risk assessment should be under taken to determine
further measures that may be necessary relating to HIV positive patients.
3.5 Patient Immunization
3.5.1 HBV: Guidance on the administration, dosage and

immunization schedules for Hepatitis B vaccine as described in the
CDC Recommendations for Preventing Transmission of Infections
among chronic hemodialysis Patients. MMWR 2001; Vol. 50 (No.RR-
5); page 1-43, at: www.cdc.gov/mmwr/PDF/rr/rr/5005.pdf.
3.5.2 Test for anti-HBs 1-2 months after last dose.
3.5.2.1 If anti-HBs is<10 mlU/mL, consider patient

susceptible, revaccinate with an additional three doses,
and retest for antiHBs.
3.5.2.2 If anti-HBs is >10 mlU/mL, consider patient immune,

and retest annually.
3.5.2.3 Give booster dose of vaccine if anti-HBs decline to <
10 mlU/mL and continue to retest annually.
3.5.3 Pneumovax: an initial dose should be given when the diagnosis

of CKD is made, a single booster should be given 5 years to complete
the lifetime series.
3.5.4 Influenza: yearly immunization is required.

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3.5.5 Shingles: all dialysis patients over 60 should be evaluated for

Zostvax.
3.5.6 Tetanus: a dose of dT should be given every 10 years.
4. Triage for rapid identification of patient with communicable diseases:
4.1 Clinical triage should be used for early identification of all patients in the dialysis
units.
4.2 Visual triage station should be placed at the entry point of the healthcare facility
4.3 Rapid identification of patients with Acute Respiratory Illness and patients
suspected of Airborne Infections is the key to prevent healthcare associated
transmission of other respiratory viruses. Appropriate infection control precautions
and respiratory etiquette for source control should be promptly applied.
5. Environmental and Equipment Cleaning / Disinfection:
5.1 After each treatment, non-disposable equipment used will be appropriately

cleaned and disinfected or sterilized. Special attention should be given to machine
control knobs and machine surfaces touched and contaminated during dialysis
procedures. Staff will wear gloves during the cleaning procedures.
5.2 Use standard cleaning and disinfection protocols and EPA registered hospital
disinfectants for MRSA & VRE.
5.3 Using friction clean and disinfect high touch surfaces in patient care -areas (e.g.,
HD chairs, HD machines, tables’ carts, bedside commodes).
5.4 Items taken into a patient station should be disposed of after use, dedicated for
use on a single patient, or cleaned and disinfected before being taken to a common
clean area or used on another patient.
5.5 Non-disposable items that cannot be comprehensively cleaned and disinfected

(e.g., adhesive tape, cloth covered blood pressure cuffs) should be dedicated for use
on a single patient.
5.6 HD Maintenance of machine and equipment
5.6.1. Dedicated machine and other equipment for HBs Ag (+) patients should be
provided.

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5.6.2. Disposable dialyzers should be used for patient with Hepatitis B and C.
5.6.3. Dialysis technician should prepare the machine by disinfection and

priming 30 minutes to 1hours before the procedure.
5.6.4 Disinfect and rinse hemodialysis machine before and after procedure.
5.7 Daily cleaning
 After each patient used, dialyzing compartment and dialysate reservoir will
be cleaned, disinfect and rinsed.
 The external surface of the machine, bedside table and patient chair or bed
will be wiped with ICC approved hospital disinfectant.
 Machine with heat disinfect capability are to be disinfected each day
according to approved ICC disinfectant or manufacturers procedure
recommendation.
 Floor shall be kept clean and clear of trash. Blood spills will be wiped up
with disposable rag and disinfect with ICC approved disinfectant refer to
Policies Cleaning and disinfection of hospital areas. Gloves must be worn for
cleaning up spills.
 Surfaces and equipment that are contaminated with blood or other
potentially infectious materials will be cleaned and disinfected properly,
using an ICC approved hospital disinfectant.
 Housekeeping is responsible for: cleaning for floors in the dialysis unit and
offices, removal of trash and dusting of nurse station.
5.8 External pressure transducer filters/ protectors should be changed after each
patient treatment. Items taken into an individual HD patient station should be
disposed of after use, dedicated for use on a single patient, or cleaned and
disinfected before taken to a common clean area used on another patient.
5.9 The internal HD machine dialysate pathway should be subjected to heat

disinfection at the end of each treatment day.
5.10 External venous and arterial pressure transducer filters/ protectors should be
changed after each patient treatment and should not be used.
5.11 Weekly
o The dialysis unit staff will hold a weekly inventory of stocks and
ordered needed supplies and perform any general cleaning
duties every week.

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o Equipment repairs will be carried out on non-dialysis days or

after dialysis treatment are completed for the day.
5.12 Monthly
o Microbial analysis will be sent each month from raw water,

product water and point of use (Surveillance Culture)
5.13 6 Months
o Chemical analysis of RO waters both raw and end product will

be sent to any DOH accredited laboratory for testing.
5.14 For cleaning and disinfection of hemodialysis machines, portable reverse

osmosis machine and the Central RO Water System, refer to:
5.14.1 Dialysis policy on Water System and Maintenance and Monitoring

Protocol.
5.14.2 EPRO 150-8000 O & M Manual Rev. 04/03
5.14.3 The Handbook on Hemodialysis (T.S. Singham PPN)
5.14.4 Chemical Dilution Procedure (POPE-04)
5.14.5 Appendix (OPE)

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6. Dialysis Water Quality and Dialysate
6.1 Adhere to current AAMI standards for quality-assurance performance of devices

and equipment used to treat, store, and distribute water in hemodialysis and for the
preparation of concentrates and dialysate.
6.2 Conduct microbiologic testing specific to water in dialysis settings.
6.2.1 Perform bacteriologic assays of water and dialysis fluids at least once a
month and during outbreaks by using standard quantitative methods
( ANSI/AAMI RD62:2001)
6.2.1.1 Assay for heterotrophic, mesophilic bacteria (e.g.,

Pseudomonas spp).
6.2.1.2 Do not use nutrient-rich media (e.g., blood agar or chocolate

agar).
6.2.2 In conjunction with microbiologic testing, perform endotoxin testing

on product water
6.2.3 Chemical testing of water to be done yearly.
6.2.4 Reverse osmosis water should be decontaminated weekly and

documented
6.3 Ensure that water does not exceed the limits for microbial counts and endotoxin
concentrations ( ANSI/AAMI RD47:1993)

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6.4 Disinfect water distribution systems in dialysis settings at least weekly

(ANSI/AAMI RD62:2001)
6.5 Wherever practical, design and engineer water systems in dialysis settings to
avoid incorporating joints, dead-end pipes, and unused branches and taps that can
harbor bacteria (AAMI: ANSI/AAMI RD62:2001)
6.6 When storage tanks are used in dialysis systems, they should be routinely
drained, disinfected with an EPA-registered product, and fitted with an ultrafilter or
pyrogenic filter (membrane filter with a pore size sufficient to remove particles and
molecules >1 kilodalton) installed in the water line distal to the storage tank
( ANSI/AAMI RD62:2001)
Association for the Advancement of Medical Instrumentation (AAMI) Hemodialysis

Water Quality Contaminant (mg/L) b
Aluminum………… 0.01 Lead………………. 0.005
Antimony…………. 0.006 Magnesium………. 4 (0.3 mEq/L)
Arsenic…………… 0.005 Mercury…………… 0.0002
Barium……………. 0.10 Nitrate (as N)......... 2.00
Beryllium………..... 0.0004 Potassium.............. 8 (0.2 mEq/L)
Cadmium…………. 0.001 Selenium................ 0.09
Calcium…………… 2 (0.1 mEq/L) Silver....................... 0.005
Chloramines……… 0.10 Sodium................... 70 (3.0 mEq/L)
Chromium………… 0.014 Sulfate.................... 100
Copper……………. 0.10 Thallium................. 0.002
Fluoride…………… 0.20 Zinc........................ 0.10
Free Chlorine…….. 0.50
Maximum Concentration
Maximum allowable chemical contaminant levels in water used to prepare dialysate and
concentrates from powder at a dialysis facility and to reprocess dialyzers for multiple use.
Water Bacteriology/Endotoxins

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Product water used to prepare dialysate or concentrates from powder at a dialysis facility
should contain a total viable microbial count of less than 100 CFU/mL and an endotoxin
concentration of less than 0.25 EU/mL.
The action level for the total viable microbial count in the product water shall be 50 EU/mL
and the action level for the endotoxin concentration shall be 0.125 EU/mL. If these action
levels are observed in the product water, corrective measures, such as disinfection and
retesting, shall be taken promptly to reduce the levels to an acceptable range.
7. Routine Serologic Testing and TB Screening
7.1 Chronic Hemodialysis Patients
7.1.1 Routinely test all chronic hemodialysis patients for HBV and HCV
infection. Promptly review results, and ensure that patients are managed
appropriately based on their testing results. Communicate test results
(positive and negative) to other units or hospitals when patients are
transferred for care. Routine testing for HDV or HIV infection for purposes of
infection control is not recommended.
7.1.2 TB Screening: CDC recommends that all HD patients be screened for TB

at Baseline and whenever exposure is suspected. Screening can be by
tuberculin skin test or blood test.
7.2 Hemodialysis Staff Members
7.2.1 Testing for HBV& HCV infection was recommended for all staff
members at the time of employment, all HBV and HBC susceptible
Hemodialysis Unit employees should be screened annually and as needed
after any blood or body fluid exposure.
7.2.2 Test all vaccines for anti-HBs 1-2 months after the last primary vaccine
dose, to determine their response to the vaccine (adequate response is
defined as >10 mIU/mL).
7.2.3 Patients and staff members who do not respond to the primary vaccine
series should be revaccinated with three additional doses and retested for
response.
8. Access guide
8.1 Vascular Access

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8.1.1
All staff shall wear eye glasses/goggles, face shield or face
mask and gown to protect against the fine spray of blood
that may occur during initiation and termination of
hemodialysis and cleaning of dialyzers.
8.1.2 Gloves and procedure gown should be worn during hooking
and unhooking procedure refers to Policy on the use of
Personnel Protective Equipment.
8.1.3 Observed hand hygiene/hand washing before and after
cannulation procedure.
8.1.4 Inspect vascular access for signs of infection before
antisepsis with ICC approved skin antiseptics to clean access
site. In case of allergy to povidone iodine, Cutasept
(Benzalkonium chloride) may be utilized.
8.1.5 Catheter hub cap or blood line connectors shall be
disinfected with ICC approved disinfectant and let the
disinfectant dry first prior to hooking.
8.2 Termination of Dialysis
8.2.1 When removing needle, PPE should be worn. Beware of

needle prick and blood and body fluids exposure.
8.2.2 Fistula needle shall be directly thrown to the sharps

container refer to Policies and Procedures on Needle/sharp
injury and Blood and body fluids exposure.
8.2.3 Blood lines from the machine shall be closed to form a

closed circuit and then discard to yellow bin.
8.2.4 Blood stained linen shall be placed in yellow bags and

properly labeled.
8.2.5 Linen soaked with blood from Hepatitis B, C and HIV

patients shall be placed in yellow bags and properly labeled.
9. Hemodialyzer Reprocessing / Reuse
9.1 Water bacterial count should be < 200 cfu/ml

9.2 ICC approved high level disinfectant (3.5% solution of PerAldecide -1 part
PerAldecide and 28.5 parts AAMI-quality water) shall be used during chemical
cleaning and to treat blood and dialysate compartment.

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9.3 Dialyzer can be reused up to 3-5 times depending on the doctor’s order for non-
Hepatitis B and C. In case of financial concern Dialyzer may be reused as long as
it passed the reprocessing criteria for case dialyzer.
9.4 Dialyzer membranes are reprocessed and disinfected for the same patient use.
Used dialyzers are rinsed with R/O water and then processed and stored in
approved high level disinfectant until the next used for a maximum of one week
to 2 weeks.
9.5 Prior to re-use, the membranes are rinsed and checked by two persons to
ensure that they are negative for residual disinfectant and that the correct
dialyzer is set up for each patient.
9.6 Dialysis unit staffs are to wear standard protective gear including water
repellent apron and follow “Universal/Standard Precautions” when handling
used dialyzer. Reprocessing of dialyzer shall be done in a well-ventilated area.
10. Procedures at the Central station
10.1 Observed hand hygiene/ hand washing before handling medication, opening
sterile packs or starting procedures.
10.2 Sterile solutions shall be opened only when needed.
10.3 Single dose vials for medications shall be used but if there is a need to use
multi-dose vials the seal shall be wiped with disinfectant before being
punctured.
10.4 No sharing of supplies, medications and instruments between patients.
10.5 All unused medications or supplies (e.g. syringes, alcohol swabs) taken to the
patients station shall not be returned to a common clean area or used on
other patients.
10.6 Monthly report of new patients with catheter, Hemodialysis Census and
serological surveillance data for Hepatitis B, Hepatitis C and HIV shall be
forwarded to Infection Control office.
11. Standard operating procedure (SOP) for chills and fever
11.1 Obtain culture from the following:
o Blood of patient from central line (if with catheter) and peripheral site.
o RO water before it enters HD machine, and
o Dialysate from HD machine

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11.2 Refer to MROD or Nephrologist in charge.

11.3 After 5 hours, if fever disappears, conclude as pyrogenic reaction if the
culture results are negative.
11.4 If with clustering of cases, culture all RO water from source faucets and
dialysate of machines involved.
11.5 Conduct further investigation and analyze common characteristics and
recommend necessary actions.
12. Other infection control procedures
12.1 Eating, drinking and smoking in patient areas are prohibited for staff.
12.2 Used needles shall always be thrown in specific needles/sharps container

that is puncture proof exclusive for the HD unit.
VI. REFERENCES
1. Handling of Soiled and Clean Linen.

2. Cleaning, Disinfection and Sterilization Practices
3. Recommendation for preventing transmission of infections among chronic hemodialysis
Patients. [Internet] MMWR 2012; 50(RR05):1-43. Available at:
http://www.cdc.gov/MMWR/PDF/rr/rr5005.pdf
4. APIC text for Infection Control and epidemiology 2014.
VII. SIGN-OFF AND REVISION HISTORY

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IC-01-041 DECEMBER 31, 2020
Owner : INFECTION CONTROL
Initiator : JAN MARVIN M. PALIJO, MSN, RN – CHIEF NURSING OFFICER
Reviewer : GINA M. GARCIA, MD – CHAIRMAN, DEPARTMENT OF MEDICINE
Approvals:
ARGYLL T. ARCIGAL, MD CHERRY PINK D. ORDINAL, MD

CHIEF OF CLINICS QMD Head
RICO M. RAYOS DEL SOL, MD

NEIL ANDREW S.J. DE LUMEN, MD
Chief Medical Officer President
Revision History
Revision Effectivity Review Prepared/Revise

Details of Revision
No. Date Due d by

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POLICIES AND PROCEDURES MANUAL

INFECTION CONTROL IN DIALYSIS

III. DEFINITION OF TERMS

Hemodialysis (HD) Removal of excess fluids and waste products by

Effluent Something that goes out from a machine.

ICC Infection Control Committee

CHIEF NURSING OFFICER CHAIRMAN, DEPARTMENT OF MEDICINE RZ DE LUMEN, MD PRESIDENT

3.2.1. HPC less than 200 CFU/ml

3.2.2. Fecal Coliform less than 1.1MPN/100ml

4. Air-conditioning and humidification equipment shall be maintained regularly to avoid

1.3 All personnel will follow hand hygiene technique in.

1.4 Personnel with infectious diseases shall abide by ICC policy.

2.9 Report blood / body fluid exposure to supervisor immediately (refer to

2.2 Hemodialysis treatments performed on patients requiring Airborne

Prepared by: Reviewed by: Conforme: Approved by:

CHIEF NURSING OFFICER CHAIRMAN, DEPARTMENT OF MEDICINE RZ DE LUMEN, MD PRESIDENT

followed as outlined in Isolation Precautions: Transmission-Based

2.3 Transmission based precautions must be followed when dealing with

2.12 Don’t use medication carts to transport medications to patient

Prepared by: Reviewed by: Conforme: Approved by:

CHIEF NURSING OFFICER CHAIRMAN, DEPARTMENT OF MEDICINE RZ DE LUMEN, MD PRESIDENT

2.14 Use aseptic technique when preparing/ handling parenteral

2.15 Never use infusion supplies such as needles, syringes, flush

2.17 Clean areas should be clearly designated for the preparation,

2.18 Adequate space (2.5 meters ) between patients, to prevent cross

3.2.2 Hemodialysis nurses caring for HBV-positive patients should

3.2.3 Follow the CDC guidelines for Hepatitis B Vaccination for

Prepared by: Reviewed by: Conforme: Approved by:

CHIEF NURSING OFFICER CHAIRMAN, DEPARTMENT OF MEDICINE RZ DE LUMEN, MD PRESIDENT

3.4 HIV-Positive Patients. According to the CDC guidelines, infection control

3.5 Patient Immunization

3.5.1 HBV: Guidance on the administration, dosage and

3.5.2 Test for anti-HBs 1-2 months after last dose.

3.5.2.1 If anti-HBs is<10 mlU/mL, consider patient

3.5.2.2 If anti-HBs is >10 mlU/mL, consider patient immune,

3.5.3 Pneumovax: an initial dose should be given when the diagnosis

3.5.4 Influenza: yearly immunization is required.

Prepared by: Reviewed by: Conforme: Approved by:

CHIEF NURSING OFFICER CHAIRMAN, DEPARTMENT OF MEDICINE RZ DE LUMEN, MD PRESIDENT

3.5.5 Shingles: all dialysis patients over 60 should be evaluated for

3.5.6 Tetanus: a dose of dT should be given every 10 years.

4. Triage for rapid identification of patient with communicable diseases:

5. Environmental and Equipment Cleaning / Disinfection:

5.1 After each treatment, non-disposable equipment used will be appropriately

5.5 Non-disposable items that cannot be comprehensively cleaned and disinfected

5.6 HD Maintenance of machine and equipment

Prepared by: Reviewed by: Conforme: Approved by:

CHIEF NURSING OFFICER CHAIRMAN, DEPARTMENT OF MEDICINE RZ DE LUMEN, MD PRESIDENT

5.6.3. Dialysis technician should prepare the machine by disinfection and

5.7 Daily cleaning

5.9 The internal HD machine dialysate pathway should be subjected to heat

CHIEF NURSING OFFICER CHAIRMAN, DEPARTMENT OF MEDICINE RZ DE LUMEN, MD PRESIDENT

o Equipment repairs will be carried out on non-dialysis days or

o Microbial analysis will be sent each month from raw water,

o Chemical analysis of RO waters both raw and end product will

5.14 For cleaning and disinfection of hemodialysis machines, portable reverse

5.14.1 Dialysis policy on Water System and Maintenance and Monitoring

5.14.2 EPRO 150-8000 O & M Manual Rev. 04/03

5.14.3 The Handbook on Hemodialysis (T.S. Singham PPN)

5.14.4 Chemical Dilution Procedure (POPE-04)

5.14.5 Appendix (OPE)

Prepared by: Reviewed by: Conforme: Approved by:

CHIEF NURSING OFFICER CHAIRMAN, DEPARTMENT OF MEDICINE RZ DE LUMEN, MD PRESIDENT