CHBT Infection Control in Dialysis Units 2 — Questions and Answers
Question 1: What does 'standard precautions' require in a dialysis setting?
- Treating all blood, body fluids, non-intact skin, and mucous membranes as potentially infectious regardless of patient diagnosis (Correct answer)
- Using full PPE only for patients with known bloodborne pathogen infections
- Wearing gloves only when handling needles; gowns are optional for routine care
- Standard precautions apply only to patients on isolation for confirmed infections
Correct answer: Treating all blood, body fluids, non-intact skin, and mucous membranes as potentially infectious regardless of patient diagnosis
Standard precautions apply universally to all patients. This includes hand hygiene, appropriate PPE (gloves for blood/fluid contact, gown/eye protection when splash risk exists), safe needle handling, and environmental cleaning.
Standard precautions apply universally to all patients. This includes hand hygiene, appropriate PPE (gloves for blood/fluid contact, gown/eye protection when splash risk exists), safe needle handling, and environmental cleaning.
Question 2: What is the purpose of dedicated supplies (e.g., non-shared supply trays) in dialysis units?
- To prevent cross-contamination between patients by ensuring supplies touched by one patient are not used for another (Correct answer)
- To reduce the cost of supplies by limiting what is stocked at each station
- To comply with CMS requirements for individual patient billing of supplies
- To prevent staff from accidentally using expired supplies stored in the common area
Correct answer: To prevent cross-contamination between patients by ensuring supplies touched by one patient are not used for another
Shared supply carts and trays are a known route for cross-contamination in dialysis units, particularly for HBV. Each patient station should have dedicated, single-use supplies that are not returned to the common supply area once brought to the station.
Shared supply carts and trays are a known route for cross-contamination in dialysis units, particularly for HBV. Each patient station should have dedicated, single-use supplies that are not returned to the common supply area once brought to the station.
Question 3: A needlestick injury occurs during hemodialysis. What is the correct immediate first aid step?
- Wash the wound thoroughly with soap and water immediately (Correct answer)
- Apply a tourniquet above the wound to prevent viral entry
- Squeeze the wound to express blood and then apply iodine solution
- Cover with a bandage and report at the end of the shift
Correct answer: Wash the wound thoroughly with soap and water immediately
Immediate thorough washing with soap and water is the first step for a needlestick injury. Mucous membrane exposures should be flushed with water. Report to occupational health immediately for baseline testing and post-exposure prophylaxis evaluation.
Immediate thorough washing with soap and water is the first step for a needlestick injury. Mucous membrane exposures should be flushed with water. Report to occupational health immediately for baseline testing and post-exposure prophylaxis evaluation.
Question 4: Methicillin-resistant Staphylococcus aureus (MRSA) colonization is detected in a dialysis patient. What precautions should be implemented?
- Contact precautions: gown and gloves for all interactions, dedicated equipment, and enhanced environmental cleaning (Correct answer)
- Airborne precautions since MRSA is transmitted by respiratory droplets
- No additional precautions beyond standard precautions are needed in dialysis
- The patient must be excluded from the dialysis unit until MRSA decolonization is confirmed
Correct answer: Contact precautions: gown and gloves for all interactions, dedicated equipment, and enhanced environmental cleaning
MRSA requires contact precautions because it is transmitted primarily by direct or indirect contact with contaminated surfaces and colonized patients. Gown and gloves reduce transmission, along with enhanced cleaning of the patient's station.
MRSA requires contact precautions because it is transmitted primarily by direct or indirect contact with contaminated surfaces and colonized patients. Gown and gloves reduce transmission, along with enhanced cleaning of the patient's station.
Question 5: What is the minimum recommended frequency for cleaning and disinfecting dialysis machine surfaces during a patient treatment?
- Immediately after any blood or body fluid contamination occurs during the session (Correct answer)
- Once per shift regardless of contamination events
- Only between patients, not during an ongoing treatment
- Weekly during routine preventive maintenance
Correct answer: Immediately after any blood or body fluid contamination occurs during the session
While machines are fully disinfected between patients, any blood or fluid contamination occurring during a treatment must be cleaned immediately using an EPA-registered disinfectant. This prevents environmental contamination that could affect staff or subsequent patients.
While machines are fully disinfected between patients, any blood or fluid contamination occurring during a treatment must be cleaned immediately using an EPA-registered disinfectant. This prevents environmental contamination that could affect staff or subsequent patients.
Question 6: Why must HBV-positive hemodialysis patients be treated in a separate room or area with dedicated machines?
- Because HBV is highly stable in the environment and routine disinfection may be insufficient to prevent transmission via shared equipment or surfaces (Correct answer)
- Because HBV-positive patients require a different dialysate formulation
- Because CMS regulations prohibit HBV-positive patients from being in the same room as other patients
- Because HBV-positive patients are more likely to have access complications requiring isolation for monitoring
Correct answer: Because HBV is highly stable in the environment and routine disinfection may be insufficient to prevent transmission via shared equipment or surfaces
HBV's environmental stability (7 days on surfaces) and high infectivity (10,000 virions per mL of blood) make it transmissible even with standard disinfection. Dedicated machines and separation prevent the cluster outbreaks that occurred in dialysis units before these policies were established.
HBV's environmental stability (7 days on surfaces) and high infectivity (10,000 virions per mL of blood) make it transmissible even with standard disinfection. Dedicated machines and separation prevent the cluster outbreaks that occurred in dialysis units before these policies were established.
CHBT Infection Control in Dialysis Units 2
What does 'standard precautions' require in a dialysis setting?