A Patient’s View of Infection-Control in the Context of Covid-19 in Hemodialysis Centers

With healthcare workers practicing frequent hand-washing in hospitals and Dialysis centers, the number of related infections and deaths in the USA have been reduced during the last decade. Despite many other precautions, CDC estimates that annual number of hospital-acquired infections and deaths are still staggering. There is no good data regarding infections originating from Dialysis centers. There are several aspects of hygiene that still miss our attention. It is the aim of this communication to point out some deficiencies in hygiene in the context of Dialysis and COVID-19.

SHOES 

In any Dialysis center, patients and their relatives enter the premises with street shoes on. Such shoes may have visited bath rooms, metro, roads and many other infected places. It is well-documented that door handles and faucets, hand operated door openers and bath room floors are contaminated with bacteria. Women’s hand bags taken in to the bathroom showed bacterial contamination. It is desirable that shoes worn by all persons coming in to the centers where patients wait or get treatment, should be left outside the premises along with personal belongings. A disposable or reusable cloth bag covering the shoes should be worn. These protocols are followed in ultra clean rooms in semiconductor industry or radioactive premises and other areas where contamination is of paramount importance.

Clothing and Accessories 

All visitors to patients in dialysis centers should stay in waiting room. If their presence is warranted inside the treatment area, they should wear a plastic gown. These gowns may be made of material which can be washed and reused.

Waiting Rooms 

Some patients arrive in gurney or wheel chair. As per the present norm, patients wait in the waiting hall before allowed inside the treatment area and also wait there after conclusion of dialysis until their transport arrives. However, the drivers, postman and other delivery persons come inside the waiting hall, freely sit in the chairs or use the bath rooms attached to the waiting hall. With the advent of COVID-19, the temperature of the patient and the caregiver are being checked after entering the treatment area. Occasionally some patient leaving the treatment area after dialysis opens the door in to the waiting hall and the incoming patient along with the caregiver (or gurney carriers) enter the treatment area, proceed to the chair, freely pick up the gloves from nurse’s stock before the nurse measures temperature of the patient and gurney carriers. This is especially risky since some patients are brought from rehabilitation centers known for infections.

Incoming patients 

It is desirable that the incoming patient stays in the parked vehicle until the chair is ready. The staff may communicate on phone and call the patient. Before entering the waiting room, the patient and caregiver should be screened.

Location of Staff in Nursing Station 

In many Hemodialysis centers, the nursing station is very low and the staff is not visible to patients needing help. It is therefore suggested that nursing stations should be at a slight elevation so that they are visible to all patients.

Hazardous Waste Removal 

It is noticed that the technicians and nurses empty the biohazard waste bins in the center. This should be discouraged since while dealing with this waste, when, an alert comes from a nearby patient and the concerned nurse is busy otherwise at that time, the garbage handling technician attends to the patient. Mistakes such as forgetting changing gloves etc in such instances are likely to happen where immediate attention to the patient is warranted.

Facilities 

The waiting room, its attached bathrooms, and Chairs should be exclusively for the use of patients.

Use of pens and Stationery 

Sometimes the center staff, without wearing gloves, sign papers for ambulance staff with the pens of the latter.

Asymptomatic Visitors and Caregivers 

The asymptomatic people are a source of contamination and temperature measurement alone is not sufficient to identify such people. Hence, as an abundant caution, all visitors including gurney carriers should be discouraged to enter the waiting room and treatment area.

Treatment of Reusable wear 

After use, overall shoes, gowns etc should be machine washed, dried, pressed and packed in card board packs. The boxes may be passed over conveyer belts through an electron [1], X-ray or gamma irradiator to make them pathogen-free.

Other Care Centers 

These guidelines apply equally to other care centers such as hospitals, clinics, blood collection centers, PT units and ER units.