Disinfection in the Hemodialysis Unit
Disinfection in the Hemodialysis Unit
Hemodialysis machine is being shared by many patients who have chronic renal failure and each one use it for average three sessions per week so close attention to it is mandatory in order to protect those patient from acquiring pathogens. The machine itself is part of the whole hemodialysis systems include which include dialysis machines, water supply, plus water treatment systems, and distribution systems, all of those elements have to be closely supervised for the terms of cleaning and disinfection as penetration of pathogen at any point of those components will lead to causing infection for the patients so close attention for the cleaning and disinfection need to be applied (plus other measures e.g. environmental surfaces , instrument , medication ,plus the staff training and their hygiene ) the hemodialysis sessions place the patient to acquire blood borne viruses and pathogenic bacteria so implementation of cleaning and disinfection are important measures to avoid such harmful incidence
As per Spaulding classification we have to classify the items into Critical, Semi critical and non-critical items based on the risk that may affect the patient so for dialysis unit ( bed or chair), bed side comode , and dialysis machines itself , and equipment e.g. blood pressure cuffs, stethoscopes need to be disinfected immediately after being used with unless the items are contaminated with blood or other body fluids it need a special attention for that kind of contamination by using a tuberculocidal agent that able to kill HBV & HIV other method is to use hypochlorite solution at the minimum of 500 ppm available free chlorine this process need to be done as a regular process to keep the items free from any pathogen for the critical items and semi critical items ( see Spaulding classification) it needs to be sterilized as it will touch the sterile body cavity or mucus membrane with high possibility of transmitting blood borne pathogens
Hemodialyzers are the machine which uses dialysis to remove impurities and waste products from the bloodstream before returning the blood to the patient so it is very sensitive and special attention for disinfecting them by using peracetic acid, heat pasteurization with citric acid, and chlorine-containing compounds after each session actually in the market all products are combined between more than one chemical and this process need to be applied for the machine before immediately after the end of the session for all patients (not only for the patient known to be positive to blood borne virus) a special disinfection cycle in the machine for disinfection using both heat disinfection and chemical ranging from 20min – 45 min Based on the model . Hemodialysis systems usually are disinfected by chlorine-based disinfectants (e.g., sodium hypochlorite 5.25),ozone, or peracetic acid.
Disinfecting any equipment must be according to the manufacturer instruction not to harm the machine
All chemical that will be used have to be used according to the recommendations of the manufacturer it is recommended that hepatitis B surface antigen (HBsAg)-positive patients need to have dedicated machine in a separate area with separate access and all consumable needed for that patient need to be separated from other consumables including the disinfectants staff assigned to give care for that patient has to be dedicated for those patient for the whole shift and they can return to negative in the next shift but not give care for the HBSAg positive and negative patient at the same shift for the possibility of cross transmission of the virus particle
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