Infection
Control Manual of Nephrology Unit
21.
Infection control plan
21.1 General precautions:
As the hospital infection control
manual regarding hand washing, disposal of sharp objects, no recap of
needles…..etc.
21.2 Specific precautions:
21.2.1 Hepatitis B patients to be dialyzed with a separate machine in a
separate room.
21.2.2 HIV patients to be dialyzed with a separate machine in a separate room.
21.2.3 Hepatitis C patients to be dialyzed with separate machines. Separate
room is advisable if available.
21.2.4 Negative patients should be dialyzed with separate machines, in a
separate room if available.
21.2.5 Assigned technician should not handle other patients with different
serology.
21.2.6 Dialysis technician should wear a separate glove for each patient.
21.2.7 Bed sheets and pillow covers should be changed and disinfected after
termination of each patient.
21.2.8 Disinfection of the dialysis machine should be done as follows:
21.2.8.1 Chemical disinfection of the inner tubing of the machine after each
dialysis session using the machine manufacturer recommendations.
21.2.8.2 Thermal disinfection of the machine at the end of the week.
21.2.8.3 Disinfection of the outer surface of the machine using cidex 2% after
each use.
21.2.9 Water treatment and distribution
systems used for the production of dialysis fluid shall be treated to remove
bacterial and chemical contaminants and should be checked monthly and whenever
necessary by hospital maintenance according to hospital policy and procedure.
21.2.10 All hepatitis B negative patients and staff should have Immunization
according to medical rules.
21.2.11 Patient’s prick site should be disinfected with alcohol in fistulas and
with Iodine for grafts.
21.2.12 Central venous catheters should be dealt with absolute aseptic
technique and by a doctor if possible.
21.2.13 all personnel caring for dialysis
patients shall understand the risk of infection transmission and take
appropriate measure to prevent and control infection to and from patients and personnel.
21.2.14 all personnel involved in patient
dialysis shall be educated and knowledgeable about the dialysis equipment
including water treatment system and all disinfection and sterilization
strategies which are necessary to prevent the transmission of infection before,
after and during dialysis.
21.2.15 Disposable dialyzers and tubes
should be used and discarded after each use.
21.2.16 Smoking, eating and drinking are
not allowed inside the dialysis area.
21.2.17 Hands must be washed with chlorohexedine
4%.
21.2.18 anything in the dirty area beyond
the imaginary dirty line should not move back to the clean area.
21.2.19 Barrier precautions:
21.2.19.1 Disposable gloves should be worn by
staff members when handling patients, body fluids or dialysis machine parts.
21.2.19.2 Scrub suits and aprons should be
worn at all time while working.
21.2.19.3 Plastic visors should be worn to any
procedure in which splashing of blood is likely to occur.
21.2.20
Cleaning procedures:
21.2.20.1 Gloves should be worn for all
cleaning procedure.
21.2.20.2 Clean the outer surfaces of HD
machine as mentioned before after HD session.
21.2.20.3 Clean the entire dialysis
environment with Clorox 1000 ppm at the end of the working hours.
21.2.20.4 Wipe any blood and body fluids
promptly using a Clorox using the special kit and maneuver. This must be done
by the nurse himself.
21.2.21 disposal of trash and infectious
waste appropriately, following the general hospital policy.
21.2.22 Hepatitis and similar infections
prevention:
21.2.22.1 All patients and staff should be
screened for HBsAg and HBsAb, Anti HCV Ab, Hepa delta, HIV1,2, according to
fixed policy:
21.2.22.1.1 When they join to the unit to
determine basic serologic status.
21.2.22.1.2 Every three months.
21.2.22.1.3 When they return to the unit after
having HD elsewhere.
21.2.22.2 Hepatitis B vaccine must be given to
staff in the usual dose if found to be HBsAg negative and HBsAb negative/or low
titer.
21.2.22.3 Hepatitis B vaccine must be given to
patients as medical rules for HD patients (double dose, 0,1,2,6) if found to be
HBsAg negative and HBsAb negative/or low titer.
21.2.22.4 New patients entering the unit with
unknown serologic status are offered heamofiltration -if available and
applicable- until two serology results one week apart are received before they
are offered heamodialysis on the machine suitable to their serology. If
heamodialysis is mandatory, those patients must be dialyzed on a dedicated
machine for unknown serology patients only.
21.2.22.5 Staff members who have HBsAb on two
consecutive occasions at a level of at least 10 samples ratio units (SRU) need
only to be tested for HBsAb annually to verify their immune status. If HBs Ab
decreases to less than 10 SRUS or becomes undetectable, such persons shall be
considered susceptible and be re-vaccinated.
Prepared by Reviewed
by
Dr. Hamdy Mehelba Dr.Abdulla
Al-Azeery
Head of Nephrology Head of Infection Control
Approved by
Dr.
Tarek Habeeb
Hospital
Director