Biosafety in Dialysis Units

1. Biosafety in Dialysis Units Dr.T.V.Rao MD Dr.T.V.Rao MD

2. Renal Failure and Technology for Survival Dr.T.V.Rao MD

3. Dialysis is a complex procedure needs good understanding to prevent infections Dr.T.V.Rao MD

4. Sanitary Environment • “Recommendations for Preventing Transmission of Infections Among Chronic Hemodialysis Patients.” (includes procedures and comprehensive program Dr.T.V.Rao MD

5. 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

6. 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 patient’s equipment. Remove/change gloves – Must perform hand hygiene after removal of gloves between each patient or station. Dr.T.V.Rao MD

7. 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

8. 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

9. HBV+ Isolation Room/AreaNew 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

10. Chronic Dialysis Facilitieshave 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. Dr.T.V.Rao MD

11. 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 Dr.T.V.Rao MD

12. 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 hospital’s program for prevention, control and investigation of infections and communicable diseases should be conducted in accordance with nationally recognized infection control practices or guidelines Dr.T.V.Rao MD

13. 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 Dr.T.V.Rao MD

14. Handwashing: Patients’ Viewpreventable issues • 11% of patients report seeing nurses or technicians who do not washing their hands or change gloves before touching their access site Dr.T.V.Rao MD

15. 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 Handwashingwe can do better Dr.T.V.Rao MD

16. 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 Dr.T.V.Rao MD

17. 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 Dr.T.V.Rao MD

18. 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) Basic Principles of Medical Asepsis Dr.T.V.Rao MD

19. 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. Medical Aseptic Principles Dr.T.V.Rao MD

20. 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 Dr.T.V.Rao MD

21. Is our dialysis unit safe?Are there opportunities to improve safety? Yes Many Dr.T.V.Rao MD

22. 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 Dr.T.V.Rao MD

23. 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 We are all humanWe make mistakes Dr.T.V.Rao MD

24. “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 Dr.T.V.Rao MD

25. 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 Dr.T.V.Rao MD