Infection Control in Dialysis:
Preventing Transmission of
Pathogens
Dialysis Technician Exam
Infection and Disease Transmission
Infection is the second most common cause of death in hemodialysis (HD)
patients. Pathogens can enter the body through a break in the skin, a
mucous membrane, or the lungs. There are three main ways diseases can
spread: direct contact, indirect contact, and droplet spread. In a dialysis
clinic, pathogens can be spread by patients, baths, visitors, equipment,
water, dialysate, and air.
Direct contact refers to touching an infected person, such as shaking hands
or kissing. Indirect contact occurs when we touch objects like dialysis
chairs, patient charts, blood pressure cuffs, IV poles, and treatment carts.
Droplet spread happens when we breathe in droplets that were coughed or
sneezed by an infected person.
Aseptic Technique and Contamination
Aseptic technique refers to being free from disease-causing germs. Clean
means not free from germs, but disinfected and usable for some steps in the
treatment. Contaminated means a sterile or clean object was touched by a
non-sterile object. Dirty means neither clean nor sterile.
Basic guidelines for aseptic technique include: - Packages are sterile only if
the package is closed and sealed. - Wash hands before touching a package
containing a sterile item. - Keep sterile packages dry. - A contaminated
object can contaminate a sterile one. - Scrub the rubber stopper of a multi-
dose vial with disinfectant before use. - All fistula needle syringe tips and
needles used to give medications or draw blood must be sterile.
Dialysate and Extracorporeal Circuit
Dialysate is made up of RO water, acid concentrate, and bicarbonate
concentrate. The extracorporeal circuit includes the dialyzer, bloodlines,
monitoring lines, heparin line, and transducer protector.
Priming removes air and germicide from the bloodlines and dialyzer. During
recirculation, ultrafiltration and diffusion help "dialyze off" any remaining
germicide.
