Infection control in the dialysis clinic requires testing, collaboration on solutions
HUNTINGTON BEACH, California — Infection management in the dialysis unit remains a high priority for caregivers, and clinical teams from Gundersen Health System presented ideas here on assessing gaps in practice and developing programs to help change the culture, even with something as simple as washing hands while doing patient care.
“Infection is the second-leading cause of death for the dialysis population,” Leah Bomesberger, RN, BSN, MPH, a critical care nurse with Gundersen Health System in Wisconsin, told attendees. Bomesberger is part of a kidney care team that manages a five-center dialysis operation that serves up to 230 patients in rural Wisconsin.
Bomesberger looked at deficiencies identified by surveyors who inspected dialysis clinics at Gundersen, and the two most common tags were V113 (staff not wearing gloves and following hand hygiene best practices) and V122 (disinfecting surfaces and equipment and having a written protocol for that practice).
One area where the spread of infection is prevalent in the dialysis clinic is at the treatment station, Bomesberger said. Adenosine triphosphate (ATP) testing is common to verify clean surfaces in health care and other business settings, like food preparation. Bomesberger showed results of ATP testing from cleaning a dialysis station, both on the dialysis machine surface and on the dialysis chair. When testing the arm rest, for example, relative light units (RLUs) — the measurement to determine the level of cleanliness — dropped from 8,560 to 1,585 after a cleaning; on the dialysis machine surface, a count of 157 RLUs dropped to 15 RLUs after cleaning. However, a reading of more than 250 RLUs is considered an unclean surface, she noted. The results “showed us that staff members should be using gloves every time they touch a machine,” Bomesberger said. “This is definitely an area we need to look at more closely.”
Jessica Adams, BSN, RN, a clinical manager at Gundersen Health System/Renal Dialysis, said there is limited information in the literature on maintaining infection-free dialysis stations.
“It is important that dialysis unit administrators and managers realize the time constraints that staff have [to make sure a station is disinfected] and should provide a tool kit with work sheets and resources” to help technicians and nurses clean dialysis stations. “It is important to form relationships with people in other clinics so you can share ideas and have partnerships,” Adams said. – by Mark E. Neumann
Adams J and Bomesberger L. Infection prevention I: Discovering and assessing gaps in practice. Presented at: National Renal Administrators Association Annual Conference; Oct. 2-4, 2019; Huntington Beach, California.
Disclosures: Adams and Bomesberger report no relevant disclosures.