DR.T.V.RAO MD 1

Dr.T.V.Rao MD

BIOSAFETY IN DIALYSIS UNITS

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

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

SANITARY ENVIRONMENT

DR.T.V.RAO MD 5

• 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

HAND HYGIENE

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

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

8

• 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

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

HANDWASHING: PATIENTS’ VIEWPREVENTABLE ISSUES

DR.T.V.RAO MD 15

HANDWASHINGWE 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

DR.T.V.RAO MD 16

• 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

TEAM APPROACH HAS GREATER ROLE IN SAFE PRACTICES

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

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)

DR.T.V.RAO MD 19

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.

DR.T.V.RAO MD 20

• 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

WHAT CAN YOU DO?

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

WE ARE ALL HUMANWE 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

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