Infection Control Measures in HD Units
Preventing Bacterial Infections and Antimicrobial Resistance Prevention and Management of HBV, HCV and HIV in Haemodialysispatients To reduce the susceptibility to infection, optimal adequacy of HD should be attained, malnutrition should be prevented or treated, optimum haemoglobin concentration should be maintained, iron overload should be avoided and a dialyser with the lowest rate of complemen
Preventing Bacterial Infections and Antimicrobial Resistance
Prevention and Management of HBV, HCV and HIV in Haemodialysispatients
To reduce the susceptibility to infection, optimal adequacy of HD should be attained, malnutrition should be prevented or treated, optimum haemoglobin concentration should be maintained, iron overload should be avoided and a dialyser with the lowest rate of complement and leukocyte activation should be used.
Preventing Bacterial Infections and Antimicrobial Resistance
Universal precautions for prevention of transmission should be rigorously respected in all HD units:
- Cleaning and disinfecting of instruments, machines and environmental surfaces after each treatment
- Avoidance of sharing articles among patients
- Frequent hand washing and use of disposable gloves
- Strict adherence to vascular access connection and disconnection protocols, tunnelled haemodialysis and peritoneal dialysis catheters care protocols.
Note 1:
When designing a haemodialysis unit, the key principles of adequate space, traffic flow from clean to dirty, and a functional design must be taken into account. Key areas to which attention must be paid include the following:
Patient waiting area
Restricted access to the dialysis treatment area
Space between dialysis machines/chairs
Storage rooms
Isolation rooms
Soiled utility rooms
Dedicated hand-washing sinks
Reprocessing rooms
Invasive procedure rooms (not within free-standing dialysis units)
Plumbing
Supplementary and administrative rooms/areas
Note 2:
Vaccinate patients regularly against influenza, pneumococcus, varicella and hepatitis B. Avoid live vaccines in kidney transplant recipients. We recommend adhering to vaccination principles outlined in chapter 12 of the KDIGO guidelines (Clinical Practice Guideline for the Care of Kidney Transplant Recipients).
Note 3:
A high index of suspicion for tuberculosis must be maintained in all patients.
Prevention and Management of HBV, HCV and HIV in Haemodialysispatients
Note 1: Hepatitis B Virus
- Patients with progressive CKD should be vaccinated against HBV preferably before they start on HD
- Screening for HBV markers should be performed in all patients starting HD or transferring from another unit and patients not immune should be vaccinated
- Screening should be repeated every six months
- Anti-HB antibody testing is recommended1-2 months after the primary series has been completed and 6-12 months thereafter. If antibody titre levels are not adequate, a booster vaccination should be administrated
- HBs Ag-positive patients should be treated in separate rooms with dedicated machines
- Immunisation against HBV should be undertaken in all HD staff members and thereafter according to a set schedule.
Note 2: Hepatitis C Virus
- Screening for HCV antibodies should be performed in all patients starting HD or transferring from another unit. A positive test should be confirmed with PCR as false positive antibody tests do occur
- Screening should be repeated every 6 months once on HD
- HCV patients should ideally be treated separately, but otherwise universal precautions must be employed throughout the unit.
Note 3: HIV infection
- Screening for HIV infection should be done in all patients starting HD and 6 monthly thereafter as well as when transferring from another unit
- Only the usual body fluid precautions attendant to routine dialysis need be followed and no special dialysis machine be set aside.
Note 4: Management of patients colonized or infected with CRE (carbapenemase resistant Enterococci)
- The emergence and spread of carbapenem resistance among Enterobacteriaceae represents a serious threat to public health
- Multiple CREs like Klebsiella pneumonia and E. coli have been reported in SA. Patients who are colonized or infected with CRE should be isolated and placed on socalled “Contact Precautions”
- Contact Precautionsinclude:
- Performing hand hygiene before donning a gown and gloves
- Donninggownandglovesbeforeenteringtheaffected patient’s room
- Removing the gown and gloves and performing hand hygiene prior to exiting the affected patient’s room
- For details on surveillance and prevention strategies refer to the CDC Guidance for Control of CRE (http:// www.cdc.gov/hai/pdfs/cre/CRE-guidance-508.pdf).
Paget G, Naicker S, et al. Guideline for the optimal care of patients on chronic dialysis in South Africa. South African Renal Society; 2015.