Preventing infections while on home hemodialysis is a critically important. You will be trained by your home hemodialysis trainer about the techniques to use to prevent infections. A good understanding of infection prevention will help with this.
Why is infection prevention important with dialysis?
Your kidney function and immune system function are tightly linked. When your kidneys are not working, they are not able to filter your blood appropriately which leads to a weakened immune system. When you are on dialysis for chronic kidney disease, the frequent use of catheters and/or needles to access the bloodstream lead to an increased risk for infection. Additionally, if you need to be hospitalized for any reason that also opens you up to an increased risk of infection. The combination of a potentially weakened immune system and an increased risk of infection means you need to be very careful when you are performing home dialysis so that you can prevent an infection from occuring.
What causes infections?
Infections are caused by microscopic organisms such as bacteria, viruses, fungi or parasites. Some of these organisms live naturally on or in your body and are helpful in maintaining your health. However some organisms are harmful, these are called pathogens. Once a pathogenic organism enters your body and multiplies, your body will respond, and if treatment used isn't successful, this can lead to death.
Understanding how microorganisms (or germs) spread can help you prevent an infection. Four common ways that disease spreads include:
Direct contact transmission – Pathogens can enter your body through open entry locations on your body, examples include your mouth, bodily fluids or via a scratch in your skin
Airborne Transmission – Pathogens can be transferred via tiny particles or droplets in the air that are inhaled by you from a person who coughs or sneezes near you for example.
Vector-borne transmission – Vectors refer to mosquitoes, fleas, ticks, rodents that can transfer a microorganism from one animal or human to another
Fomite transmission – When an inanimate solid object is contaminated by an infected individual and you come into contact with it. This is why it is so important to clean surfaces.
Infection prevention tips for home hemodialysis:
As you go through the training process of learning to perform home hemodialysis, your trainer will teach you the various methods to reduce or prevent the spread of infection. You will learn the same infection prevention techniques that the nurses and technicians use at the in-center hemodialysis centers. Your trainer will also discuss the appropriate cleaning supplies needed specific to your dialysis machine.
You can also review the CDC education course “Infection Prevention in Dialysis Settings”, which covers the same infection prevention principles but is designed for healthcare workers as a reference.
Below are 4 key tips to keep in mind to help prevent infection that your instructor will likely review with you:
1. Keep the hemodialysis treatment area clean
Disinfect hard surfaces such as tables, nightstands, etc., in your dialysis room before and after each use
Clean your dialysis chair before and after each use
Clean and sanitize your dialysis machine per your training instructions
Clean any instruments used at the time of dialysis such as blood pressure cuff, stethoscope, etc., before and after each use
Clean up any blood spills with gloves and a 1:100 ratio of bleach to water and discard the paper towel immediately after cleaning up
Have a checklist near your treatment chair so you can make sure you have completed all disinfecting procedures prior to starting treatment.
2. Wash your hands regularly with soap and water
Hand washing is one of the best ways to prevent the spread of infection. Wash hands for at least 20 seconds with soap and water. Be sure you get all areas of the hands including under your fingernails and the back of your hands.
3. Take care of your access site: Depending on the type of dialysis access site you have, the instructions for accessing your site will vary. Fistulas and grafts are less likely to get infected compared to catheters so talk with your doctor to find out if you are a candidate for a fistula or graft.
Below are links to the CDCs checklists for properly accessing various types of dialysis access sites. Be sure to check with your dialysis trainer to ensure you are following the proper guidelines as some steps may vary based on your specific needs.
It is imperative that you follow specific instructions for accessing your site properly to ensure you do not contaminate the site.
CDC checklist for:
4. Ensure supplies you use are sterile
Check your supplies when you receive them and immediately before use. If the package is torn or wet, do not use the supplies and ask for replacements.
Only open supplies that are sent to you when you are ready to use them.
What about water contaminates at my home?
Prior to starting home hemodialysis, you must have your water tested to ensure it meets the EPA drinking water standards. If it does not, you will have to use bagged dialysate.
If your water does meet the EPA drinking water standards, you will have a water treatment system for use with your dialysis machine. Depending on your water treatment system, you may have to disinfect your water before each use to ensure it does not have any bacteria, chlorine, chloramines, or other substances in it that could be harmful. This will vary based on your specific water treatment system.
Your dialysis center should be in close contact with your water supply company, and they will be alerted if there are any changes with the water supply to your home.
If there is a boil advisory, you can use bagged dialysate until the water company says it is safe to drink and you have had the water re-tested to ensure it meets the EPA drinking water standards again.
Following your dialysis center protocols for your specific home hemodialysis will ensure you remain safe from any infections that could come from your home water source.
How can I prevent infections when out and about?
Keep hand sanitizer with you - this can used if your hands are not visibly soiled, but it needs to be at least 60% alcohol based in order to be effective.
If friends or family don’t feel healthy plan your visit for another time.
If you aren’t feeling well and need to cough or sneeze cover your mouth with your hands or cough into your shirt sleeve. Make sure to throw away the tissue away and wash your hands.
Make Infection Prevention Techniques a Habit
Infection prevention techniques are extremely important to anyone on dialysis whether dialysis is performed in a dialysis clinic or at home. Knowing the proper techniques can keep you safe from unnecessary infections. Make the techniques and procedures a habit by regularly following the recommendations from your dialysis trainer, this will help you stay consistent with your infection control procedures, and minimize the opportunities for an infection to occur. If you see any redness near you access point or have soreness around your access point call your dialysis center team contact immediately.
References/Resources
“Patients with Catheters.” Centers for Disease Control and Prevention, 2022
“Audit Tool: Hemodialysis Stations Routine Disinfection Observations.” Centers for Disease
Control and Prevention, Sept. 2022
“How Infections Spread.” Centers for Disease Control and Prevention, Sept. 2022
“Dialysis Wall Boxes and Drains.” Centers for Disease Control and Prevention, 2022
“Audit Tools and Checklists.” Centers for Disease Control and Prevention, 2022
“Checklist: Arteriovenous Fistula/ Graft Decannulation.” Centers for Disease Control and Prevention
“Checklist: Arteriovenous Fistula/Graft Cannulation.” Centers for Disease Control and Prevention
“Checklist: Hemodialysis Catheter Connection.” Centers for Disease Control and Prevention
“Checklist: Hemodialysis Catheter Disconnection.” Centers for Disease Control and Prevention
“Checklist: Hemodialysis Catheter Exit Site Care.” Centers for Disease Control and Prevention
“Infection Control.” Centers for Disease Control and Prevention
“Frequent Questions About Hand Hygiene | Handwashing | CDC.” Centers for Disease Control and Prevention
“Water Treatment for Home Hemodialysis.” Home Dialysis Central
The role of the immune system in kidney disease. Review publication.
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