The risk of transmitting bloodborne pathogens, including hepatitis C virus, in a hemodialysis unit can be high due to environmental contamination with blood.
Our clinic recently participated in a “test of change” utilizing a new Dialysis Station Routine Disinfection Checklist developed by CDC and their Dialysis Collaborative in hopes of decreasing the potential for cross-contamination and recommending a “best practice.”
The St. Albans clinic is a free standing, 9-station hemodialysis unit staffed by registered nurses and technicians. It is one of six satellites affiliated with the University of Vermont Medical Center.
We reviewed the proposed Dialysis Station Routine Disinfection Checklist noting that the major difference from our current practice was discharging the patient from the treatment station before performing terminal station disinfection. 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.
Initially, the change in workflow was challenging. Staff felt time was wasted waiting for the patient to leave the station before starting to disinfect it. Patient turnover was extended by 10-15 minutes with an overall increase of approximately 20-30 minutes for the day. If patients required prolonged post-treatment care, they were moved out of the station and into a holding area.
As the week progressed, staff realized the “waiting period” was actually a positive change:
- The risk of cross-contamination related to taking the patient’s final blood pressure was eliminated. Prior practice required hand hygiene and clean gloves before pushing the button on the “just cleaned, ready for the next patient” machine for the blood pressure cuff to inflate;
- Technicians were able to slow down, complete all treatment documentation, and mentally collect their thoughts before moving on to the next patient;
- Staff didn’t feel rushed to have everything done before the patient left the station, instead they visited with the patient, resulting in improved patient satisfaction; and
- Once staff acquired a rhythm, patient schedules were actually minimally impacted, 5-10 minutes/day.
At the end of the one-week trial, staff requested that they continue using the CDC-recommended practice. 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.
Peggy Bushy, RN, CDN and Linda Foster, RN, work in Renal Services at the University of Vermont Medical Center. Sally Hess, MPH, CIC, works in Infection Prevention at the University of Vermont Medical Center.