Checklist helps staff properly disinfect dialysis centers

A new checklist is available to help health professionals at dialysis centers ensure they are cleaning stations between outpatient hemodialysis patients in a way that best prevents bloodstream infections caused from cross-contamination.

The Centers for Disease Control and Prevention and its Dialysis Bloodstream Infection Prevention Collaborative have come up with a two-part checklist that details what should be done before someone starts disinfecting a dialysis station and what should be done after a patient has left the station.

The list, posted to the CDC website in early July, includes items such as ensuring the priming bucket has been emptied and ensuring surfaces are visibly wet with disinfectant. Unclean areas increase the risk of transmitting hepatitis C and other bloodborne pathogens.

“The CDC has been involved in a number of outbreaks in dialysis centers where we have encountered stations being cleaned before the previous patient has left,” said Priti Patel, MD, MPH, head of the CDC's dialysis safety efforts. “It is best to wait until each patient has finished their treatment and has left the station.”

Dr. Patel said they have talked to staff members at some facilities across the country who said a culture has evolved during the past 20 years where it is OK to start wiping down a station while the current patient is still there. Part of it may be driven by a desire to perform more efficiently, or the next patient may be pressing staff to begin treatment, she said. But Dr. Patel said it is time for that culture to change and physicians can be key in the transformation.

“Physicians are the leaders in these settings, and they can be the champions on insisting on a culture that makes sure the facility is safe for patients and health care workers,” Dr. Patel said.

Success achieved at clinic

A freestanding, nine-station hemodialysis unit in St. Albans, Vt., used the new Dialysis Station Routine Disinfection Checklist in an effort to change its culture. The clinic is one of six satellites affiliated with Fletcher Allen Health Care, an academic medical center in Vermont.

Prior to the checklist, the clinic did not discharge the patient from the treatment station before beginning to disinfect the terminal station, according to a blog two nurses and the head of infection prevention at Fletcher Allen Health Care wrote about their experiences for the CDC website.

“Staff agreed to a one-week trial of the new checklist, if only to prove that this 'waiting for the patient to leave the station' was not truly feasible,” the authors wrote.

At first, waiting times increased for patients. But as the week went on, the staff realized the “waiting period” was actually a positive change, the women wrote. Technicians were able to slow down, complete all documentation and collect their thoughts before moving to the next patient. Once the staff had a rhythm, patient schedules were minimally impacted, by five to 10 minutes a day.

“At the end of the one-week trial, staff requested that they continue using the CDC-recommended practice,” the bloggers wrote. “This 'test of change' bodes well for the future: Not only was patient safety enhanced, but staff were proud to engage in the protocol and share it with their colleagues at our other centers.”

Suhail Ahmad, MD, a professor of medicine in the Division of Nephrology at the University of Washington in Seattle, said the facilities he has encountered follow the procedures outlined in the checklist. He said it is important that physicians ensure that medical staff members at dialysis centers are careful to follow guidelines established to prevent infections.

“The safety of patients and quality of care is the responsibility of the nephrologists,” said Dr. Ahmad, who also is chief medical officer for the Northwest Kidney Centers in Seattle.