Download 60.30.07 Management of Hemodialysis Patients with Infectious

MANITOBA RENAL PROGRAM
SUBJECT
 Management of Hemodialysis Patients with Infectious
Diseases Protocol
SECTION
60.30 Protocols
CODE
60.30.07
AUTHORIZATION
 Professional Advisory Committee, Manitoba Renal Program
 Nursing Practice Council, St. Boniface Hospital
EFFECTIVE DATE
September 2008
REVISION DATE
September 2013
PURPOSE:
1. To provide guidelines to staff when hemodialysis patients with various infectious diseases are treated in the
same dialysis unit.
DEFINITIONS:
AIRBORNE INFECTION ISOLATION ROOM (formerly called negative pressure isolation room):
An airborne infection isolation room (AIIR) is a single-occupancy patient care room used to isolate persons with
suspected or confirmed infectious airborne or airborne/contact disease. Environmental factors are controlled to
minimize the transmission of infectious agents usually spread from person-to-person by droplet nuclei
associated with coughing or aerosolization of contaminated fluids. AIIRs have requirements for controlled
ventilation (negative pressure), air pressure, and air filtration. Airborne infection isolation rooms should provide
negative pressure in the room (so air flows into the room), an air flow rate of 6-12 air changes/hour, and direct
exhaust of air from the room to the outside of the building or recirculation
PRIVATE ROOM:
A room separated from other areas by walls, with its own entrance or doorway that can be closed.
PRIVATE BEDSPACE:
A patient station separated from other areas by closed curtains or privacy screen when a private room is not
available.
POLICY:
1.
HBsAg+ patients will be managed in a private room in compliance with the Renal Health Centre’s Regional
Health Authority Infection Control and Prevention Manual/directives. WRHA on-line resource can be found
at: http://home.wrha.mb.ca/prog/ipc/manual_hospital.php
2.
Refer to MRP Protocol 60.30.08 Management of HBsAg Positive Hemodialysis Patients (insert link) for
considerations regarding HBsAg+ patients.
3.
Isolate patients with the infectious diseases in a Private Room in the following order of priority:
a. Infectious tuberculosis, suspected or confirmed
▪ Dialysis Units without airborne infection isolation rooms should transfer patients with
suspect/known infectious Mycobacterium tuberculosis to a unit with an airborne infection isolation
room.
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b. Measles
▪ Dialysis Units without airborne infection isolation rooms and there are no susceptible,
immunocompromised patients: if transfer is not feasible; consider using a private room with door
closed.
c. Varicella
▪ Dialysis Units without airborne infection isolation rooms and there are no susceptible,
immunocompromised patients: if transfer is not feasible; consider using a private room with door
closed.
d. Disseminated zoster
e. Extensive localized zoster
f. Patients who are HBsAg+.
g. Patients requiring isolation for known Antibiotic Resistant Organisms (ARO).
h. Patients transferred/traveling from outside Canada who have not been screened according to Policy
60.30.09 Traveling Dialysis Patients Screening for Hepatitis B, MRSA and VRE.
i. Patients transferred/traveling from outside Manitoba who have not been screened according to Policy
60.30.09 Traveling Dialysis Patients Screening for Hepatitis B, MRSA and VRE.
j. Patients with uncontrolled diarrhea/secretions that are not/cannot be contained.
k. Patients on Contact Precautions for other infectious diseases not listed above.
l. Patients on Droplet Precautions.
4.
When a private room is not available, patients with infectious diseases should be separated from other
patients in an area geographically removed from the main stream of activity.
5.
Dialyze patients with infectious diseases with dedicated equipment, instruments, supplies, and medications.
Patient that are HBsAg + should only be dialyzed with a dialysis delivery system that is dedicated to such
patients.
a. Items taken into the dialysis station should either be disposed of, dedicated for use only on a single
patient, or cleaned and disinfected before being taken to a common clean area or used on another
patient:
▪ Non-disposable items that cannot be cleaned and disinfected (e.g., adhesive tape, cloth-covered
blood pressure cuffs) should be dedicated for use only on a single patient.
▪ Unused medications (including multiple dose vials containing diluents) or supplies (e.g., syringes,
alcohol swabs) taken to the patient’s station should be used only for that patient and should not be
returned to a common clean area or used on other patients.
6.
At the completion of dialysis:
a. The dialysis delivery system (internal pathways and external surfaces) shall undergo cleaning and
disinfection as outlined in MRP Procedure 30.20.07 Use of Fresenius 5008 Delivery System
http://www.kidneyhealth.ca/wp/wp-content/uploads/pdfs/P&P/P&P_30.20.07.pdf.
Degreasing/cold disinfection with bleach is required following all hemodialysis treatments for patients
that are HBsAg+. (See policy 60.30.08 title) For patients with other infectious diseases, follow routine
cleaning and disinfection practices as per MRP procedure.
b. The delivery system is then covered with a clean sheet and the private room/area shall undergo
terminal cleaning and disinfection with changing of bedside curtains. The bed/chair, table, and
television remote controls must be included in the cleaning and disinfection.
▪ After each patient treatment, clean environmental surfaces at the dialysis station, including the
dialysis bed or chair, countertops, and external surfaces of the dialysis machine, including
containers associated with the prime waste.
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Give special attention to cleaning control panels on the dialysis machines and other surfaces that
are frequently touched and potentially contaminated with patients’ blood.
c. Reusable equipment and supplies are cleaned and disinfected before use on another patient.
d. If equipment requires servicing by a dialysis technologist, the delivery system must be disinfected as
outlined above and the technologist shall be informed the equipment was used by a patient with an
infectious disease.
7.
Patient Education: Upon initiation of precautions, the nurse will explain the protocol and the rationale to the
patient and/or family.
A. Management of dialysis patients on Additional Precautions
1. Dialysis patients requiring Additional Precautions shall be placed in a private room in compliance with
the Manitoba/regional/facility isolation guidelines.
2. If a private room is not available use the following management guidelines to create a private bedspace.
a. Consult the site Infection Control Practitioner or designate for guidance.
b. Manage patient bed space as isolation room; segregate patient or cohort with others with the same
organism.
c. Place privacy curtain around bed space to provide a barrier around the patient.
d. Place Additional Precautions sign on curtain or bed.
e. Hand washing sink should be available in bed space or nearby. If sink is not readily accessible,
alcohol based hand rub with a minimum of 60% alcohol must be available.
f.
Clean and disinfect patient care equipment after each patient use, prior to removal from isolation
space.
g. Follow standard dialysis cleaning and disinfection procedures for cleaning after treatment. Change
privacy curtains for ARO positive patients after every use. For patients on other Additional
Precautions, change curtains when visibly soiled.
REFERENCES:
Association for Professionals in Infection Control and Epidemiology (APIC) 2010. Guide to the Elimination
of Infections in Hemodialysis http://www.apic.org/Resource_/EliminationGuideForm/7966d850-0c5a48ae-9090-a1da00bcf988/File/APIC-Hemodialysis.pdf
CDC MMWR April 27, 2001 / 50(RR05); 1-43 Recommendations for Preventing Transmission of Infections Among
Chronic Hemodialysis Patients. http://www.cdc.gov/mmwr/PDF/rr/rr5005.pdf
RESOURCES:
Dialysis Infection Prevention and Control Working Group
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