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BIOSAFETY IN DIALYSIS UNITS

Dr.T.V.Rao MD

DR.T.V.RAO MD

RENAL FAILURE AND TECHNOLOGY FOR SURVIVAL

DR.T.V.RAO MD

DIALYSIS IS A COMPLEX PROCEDURE NEEDS GOOD UNDERSTANDING TO PREVENT INFECTIONS

DR.T.V.RAO MD

SANITARY ENVIRONMENT
Recommendations

DR.T.V.RAO MD

for Preventing Transmission of Infections Among Chronic Hemodialysis Patients. (includes procedures and comprehensive program

HAND HYGIENE
Current guidance is gloves whenever providing patient care or touching a machine surface, and change required both ways in going from one to the other
DR.T.V.RAO MD

GLOVES & HAND HYGIENE


Hand washing is the most important measure to prevent contaminant transmission.--CDC: Wear gloves Whenever caring for a patient or touching the patients equipment. Remove/change gloves Must perform hand hygiene after removal of gloves between each patient or station.

DR.T.V.RAO MD

GLOVES & HAND HYGIENE


Hand hygiene Use soap & water or alcohol-based antiseptic hand rub Visibly soiled vs. not visibly soiled

Intravascular catheters
- Staff should wear clean or sterile gloves when changing the dressing on IV catheters - Hand hygiene performed before & after palpating catheter insertion sites, as well as before & after accessing or dressing an IV catheter
DR.T.V.RAO MD

CLEANING & DISINFECTING OF CONTAMINATED SURFACES, MEDICAL DEVICES, & EQUIPMENT

Clean & disinfect medical devices & equipment after each patient Scissors, hemostats, clamps, stethoscopes, blood pressure cuffs

Blood spills cleaned effectively & immediately


Intermediate-level disinfectant
DR.T.V.RAO MD

HBV+ ISOLATION ROOM/AREA NEW REGULATIONS


Effective Feb 9, 2009, every new facility MUST include an isolation room for treatment of HBV+ patients, unless the facility is granted a waiver of this requirement

For existing units in which a separate room is not possible, there must be a separate area for HBsAg positive patients
DR.T.V.RAO MD

CHRONIC DIALYSIS FACILITIES HAVE A SELF AUDIT


Survey of this Condition requires: observations of care delivery, interviews with staff and patients, review of medical records, facility logs, policies and procedures and quality assessment and performance improvement (QAPI) documentation.
Medical and administrative records should demonstrate recognition of any potential infection and actions taken to decrease the transmission of infection within the dialysis facility. If deficient practices noted in infection control, techniques are multiple, pervasive, or of an extent to present a risk to patient health and safety, Condition level non-compliance should be considered.

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CHRONIC DIALYSIS CONDITIONS


Sanitary Environment: Recommendations for Preventing Transmission of Infections Among Chronic Hemodialysis Patients. (includes procedures and comprehensive program Hepatitis: Recommendations for Preventing Transmission of Infections Among Chronic Hemodialysis Patients, (precautions, testing, immunization, isolation, surveillance, response, training

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HOSPITAL CONDITIONS IN INFECTION CONTROL


The hospital must provide a sanitary environment to avoid sources and transmission of infections and communicable diseases. There must be an active program for the prevention, control, and investigation of infections and communicable diseases.

The hospitals program for prevention, control and investigation of infections and communicable diseases should be conducted in accordance with nationally recognized infection control practices or guidelines
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COMMON PATIENT SAFETY COMPLAINTS


Staff are not washing their hands Staff do not change gloves between patients Staff not wearing appropriate PPE Given the wrong medication Given the wrong dialyzer Staff not performing safe procedure (catheter care) Staff unskilled in cannulation Staff not performing appropriate patient assessments

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HANDWASHING: PATIENTS VIEW PREVENTABLE ISSUES


11% of patients report seeing nurses or technicians who do not washing their hands or change gloves before touching their access site

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HANDWASHING WE CAN DO BETTER


Five Key Factors
Time: 15 seconds Water: warm Soap: 1 teaspoon liquid Friction: rub in circular motions from fingers to 1 inch above wrist if not visibly soiled (moving from dirtiest to cleanest) and 1 inch above area of contamination Drying: begin with fingers and move upward DRY HANDS FIRST THAN TURN OFF FAUCET WITH PAPER TOWEL

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TEAM APPROACH HAS GREATER ROLE IN SAFE PRACTICES

Personnel: All team approach Patient safety committee Time: management in shortage of staff Training staff Educating patients Evaluating ongoing patient safety Technology: Modifying systems as needed

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BE A ROLE MODEL
Research shows the action of Clinicians influences the behavior of others, especially co-workers and patients Practice hand Hygiene and show you are serious about your health, the health of your co-workers and the health of your patients Model a cooperative spirit and ask patients to watch you was your hands so that they are assured it has been done Be an advocate for self-management, including encouragement of self-cannulation

Encourage patients to take an active role in safety and to question staff when they believe procedures are not being followed consistently or safely
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BASIC PRINCIPLES OF MEDICAL ASEPSIS


Clean Technique used to prevent the spread of microorganisms Hand washing AGAIN Carry soiled items away from body Do not place soiled items on floor Client instructed not to cough, sneeze, breathe on anyone; expectorate into tissues; cover mouth and nose when coughing and sneezing; (Airborne)
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MEDICAL ASEPTIC PRINCIPLES


Do not shake linens. Clean from least soiled to most soiled. Dispose of soiled or used items directly into receptacles. Place bodily discharge and drainage into plastic bags or containers (e.g. briefs, diapers; linens; specimens). Pour bath water, mouth wash directly into sink drain.

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WHAT CAN YOU DO?


Wash your hands Help design a culture of safety in your unit

Handwashing is recognized as patient safety issue in dialysis units NON Adherence to procedures is a major source of medical mistakes
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IS OUR DIALYSIS UNIT SAFE?


ARE THERE OPPORTUNITIES TO IMPROVE SAFETY? YES MANY

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SELF AUDIT TO IDENTIFY THE INFECTIONS

Medical and administrative records should demonstrate recognition of any potential infection and actions taken to decrease the transmission of infection within the dialysis facility
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WE ARE ALL HUMAN WE MAKE MISTAKES

Mistakes are common. They occur daily. Mistakes are part of our every day lives. When you are admitted to a hospital (or dialysis unit) you expect

NO MISTAKES So patient too expect the same


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Medical errors most often result from a

complex interplay of multiple factors. Only rarely are they due to the carelessness or misconduct of single individuals.
Lucian L. Leape, M.D. A leading patient safety expert from Harvard University

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The programme created by Dr.T.V.Rao MD for better understanding on basic issues in Safe practices in Dialysis Units for Medical and Health Workers in the Developing World Email doctortvrao@gmail.com

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