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DESCRIPTIONS:
Hemodialysis is the diffusion of dissolved particles from one fluid compartment into another across a semipermeable membrane.
The client’s blood flows through one fluid compartment, and the dialysateis in another fluid compartment
FUNCTIONS OF HEMODIALYSIS:
Cleanses the blood of accumulated waste products
Removes the by-products of protein metabolism such as urea, creatinine, and uric acid.
Removes excessive fluids
Maintains or restores the buffer system of the body
Maintains or restores electrolyte levels
PRINCIPLES OF HEMODIALYSIS: Diffusion is the movement of particles
from an area of greater concentration to one of lesser concentration
Osmosis is the movement of fluids across a semipermeable membrane from an area of lesser concentration of particles to an area of greater concentration of particles
Ultrafiltration is the movement of fluidacross a semipermeable membrane as a result of an artificially created pressure gradient
DIALYSATE BATH:
A dialysate bath is composed of water and major electrolytes
The dialysate need not be sterile because bacteria are too large to pass through; however, the dialysate must meet specific standards, and water treatment systemsare used to ensure a safe water supply
NOSOCOMIAL INFECTION ASSOCIATED WITH HEMODIALYSIS:
Dialysis patient have a compromised immune system and other disorder that place them at risk for infectious diseases
A typical hemodialysis system consist of a water supply
A system for mixing water and concentrated dialysis fluid
A machine to pump the dialysis fluid through the artificial kidney
Which we refer to as hemodialyser or dialyser
Bacterial and chemical contaminant in hemodialysis system
The dialyser is connected to the patient circulatory system, and the blood pump through it to accomplished dialysis by means of a membrane to removed waste product from the patients blood
Bacterial and chemical contaminant in hemodialysis system
BACTERIAL CONTAMINATION OF WATER
There are many situations where certain types of gram negative bacteria can persist and actively multiply in aqueious environment associated with hemodialysis equipment
This may affect patient by septicemia or endotoxemia.
E.g. water borne bacteria
Acinetobacter
Aeromonas
Serratia
xanthomonas
BACTERIAL CONTAMINATION OF WATER
WATER SUPPLY
1. Water treatment system – water used for the production of dialysis fluid must be treated to remove chemical and microbial contaminants
e.g. reverse osmosis and water softener
2. Distribution system - water that has passed through the water system , may be distributed to individual dialysis machine where it is combined with dialysate concentrate
Routine disinfection of water or dialysate should be performed at least weekly
An ultrfilter distal to the storage tank is recommended
WATER SUPPLY
3. Hemodialysis machine – to ensure adequate disinfection of the machine . The disinfectant must reach all parts of the system’s fluid pathways
BACTERIAL CONTAMINATION OF WATER
Disinfection of the hemodialysis system
The total dialysis system (water treatment system, distribution system, dialysis machine) should be included in the disinfection procedure.
Chlorine-based disinfectant, such as sodium hypochloride solution, are convenient and effective in most parts of the dialysis system
Aqueious formaldehyde, peroxyacetic acid or glutaraldehyde solution produces good disinfection results.
BACTERIAL CONTAMINATION OF WATER
Monitoring of water and dialysis fluid
Water samples should be collected from a source as close as to where water enters the dialysate concentrate –proportioning unit
Water samples should be collected at least monthly
Dialysis fluid samples should be collected during or at the termination of dialysis from a sourece close to where the dialysis fluid enters or leaves the dialyser.
Hemodialyser reuse
Dialyser can be reuse if performed according to strict and established protocol.
Reprocess hemodialysers constitute high level rather than sterilization
Peracetic acid and glutaraldehyde are effective
Also formaldehyde – need to exposed up to 36 hours
Patient should have a specific station assigned to them, like chairs and tables should be clean after use
Sharing of ancillary supply, like BP cuff, scissors, thermometer, trays should be avoided
Non disposable items should be clean or approximately disinfected between use
Medications should be prepared and distributed from centralized area.
Clean and contaminated area should be separated
Separate handwashing area
Disposal of blood and waste should be separated
pantry room should always be closed
Non-disposable equipment should be cleaned and disinfected or sterilized.
Wear disposable gloves when touching the patient.
Also, wear mask, face shield or eye wear during cleaning of the dialyser
Special care should be taken to prevent needle sticks injury. NEVER RECAP
Staff Nurse should not smoke, eat or drink in the dialysis treatment area
The patient’s dialysis record should include all mishaps, demographic data, laboratory results, and all incidences, like needle sticks injury.
Also include the machine use
And prophylactic measures
Prevention of Infection at Hemodialysis
Patient with infection shall be treated in a separate room and uses a machine designated only for patien with such case
Dialyser of the patient with hepatitis shall be discarded after use
Prevention of Infection at Hemodialysis
Nurses caring for such patient should adhere to standard precaution
Proper disposal of waste and other consumable shall be followed
New patient shall undergo hepatitis screening and other blood test
Prevention of Infection at Hemodialysis
All patient who have non-reactive anti-Hbs result should received 3 doses of hepatitis vaccine
All regular patient should have their hepatitis profile every 6 months
Terminal cleaning of room should be done
Prevention of Infection at Hemodialysis
Patient with HIV/AIDS shall be reported to HACT for counselling