Infection prevention in dialysis patients

Infection is the most common cause of hospitalization and the second most common cause of mortality among Hemodialysis (HD) patients, after cardiovascular disease. HD patients are exposed to different types of infection, which include bloodstream infections and localized infections of the vascular access, blood-borne infections with hepatitis B virus (HBV), hepatitis C virus (HCV), and/or human immunodeficiency virus (HIV), and airborne infections like tuberculosis, covid, etc.

Sources of Infections
The high risk of infections in dialysis patients is due to several factors including the close distance of dialysis patients to each other, the fast patient turnover between dialysis sessions, and the health of the person receiving dialysis. Many dialysis patients have other health conditions and/or a weakened immune system which can increase susceptibility to infections, especially when infection prevention practices are not strictly followed by dialysis staff. These health conditions often result in dialysis patients having frequent admissions to hospitals which expose them to antibiotic therapy and drug-resistant bacteria

Sources of infections could be contaminated water, equipment, and environmental surfaces in the treatment area and patients with infections who pose a risk to other nearby patients being treated in the dialysis unit.

Infections during Hemodialysis
Hepatitis B and hepatitis C are common infections which can occur in dialysis patients. They occur primarily due to cross contamination.

Other types of infections that occur in dialysis patients include bacterial infections like Staphylococcus aureus. This bacteria is often referred to as “staph,” and is commonly carried on the skin or in the nose of healthy. Other bacteria also can cause infections.

These bacterial infections can be linked to the type of bloodstream access the dialysis patient has. There are two main types of bloodstream access. One is a plastic tube that is capped off and remains in one of the blood vessels (a dialysis catheter). The second is a vein that has been surgically enhanced to make it stronger (a fistula). Studies show that patients with dialysis catheters are more likely to acquire an infection than patients who have fistulas.

Infections acquired in dialysis are generally the result of cross-contamination. That means the transfer of bacteria from patient to patient or from surface-to-surface (dialysis machine, medications, fistula/catheter, telephone, medical chart, door knob, supplies, computer keyboards, and more). The handling of patients, supplies, and equipment thus requires a very high degree of focused attention by care providers. Consistent, standard, reliable application of simple efforts to prevent infection is important to ensure the better health of dialysis patients.

Vaccination is the best method to prevent hepatitis B infections. Avoiding reuse of dialysis tubes, preferring single use dialyzers, using single use syringes/needles, using hand hygiene before handling a patient and using separate hand glove for each patient are some of the methods to prevent hepatitis B and hepatitis C infection. There is no vaccine for hepatitis C. However there are very effective oral medicines for treating hepatitis C.
Prevention and Control of Infections in Hemodialysis Units

The key to protecting dialysis patients from the development and/or transmission of infection is providing education and increasing the knowledge base of patients and staff. Here is some information that will be helpful to consumers undergoing dialysis and their loved ones.

What patients can do?
Clean your fistula site with soap and water before every dialysis treatment.
•    Clean your hands with waterless alcohol-based sanitizer or with soap and water before you start your dialysis session and after you leave.
•    If you have a catheter, wear a mask while the nurse is hooking you up to the dialysis machine to prevent germs from your mouth from falling or spraying onto the catheter.
•    If you don’t have a permanent fistula, but will need dialysis for your lifetime, discuss the early placement of a fistula with your doctor, before the need for dialysis.
•    Get the flu vaccine every year. (The CDC recommends that those with chronic medical conditions get vaccinated).
•    Ask for a hepatitis C serology and hepatitis B serology blood test before starting dialysis treatment, and then on a routine basis.
•    Get the hepatitis B vaccine.
•    Syringes and needles must be used one time only. Before receiving an injection, ask if the needle and syringe have been newly opened for you.
•    Inquire if the center uses single-dose vials of medication or multi-dose vials with strict controls. If they use multi-dose vials, ask if they unwrap a new syringe and needle for each dose of medication.
•    If you will receive intravenous fluids, request that they do not use the bag for other patients or set up the intravenous tubing until they are ready to administer fluid to you.

What patients can observe/ask about?
Does the dialysis staff put a new external (transducer) filter on the dialysis machine for every patient and replace the filter when it is saturated with blood. This prevents blood from contaminating the inside of the dialysis machine and prevents patient exposure to contaminants.

•    Does the dialysis staff clean their hands before and after they touch you or your dialysis machine?
•    Does the dialysis staff use a separate glove for you?
•    Does your nurse wear a mask during the initiation and discontinuation of the treatment with a catheter?
•    Observe if the dialysis staff cleans the skin of your fistula well with an antiseptic before hooking you up to the dialysis machine.
•    Observe if the chair, table, and machine are cleaned between each patient use.
•    Ask if the water used for dialysis is routinely tested for bacteria and if there is a policy in case levels are higher than acceptable.
•    Ask if your dialysis caregiver has received the flu vaccine this year.

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