CHBT Infection Control in Dialysis Units 1 — Questions and Answers
Question 1: Why are dialysis patients at significantly higher risk for bloodstream infections compared to the general population?
- Frequent vascular access cannulation, immunosuppression from uremia, and repeated exposure to healthcare environments (Correct answer)
- Dialysis removes all protective antibodies from the blood each session
- Dialysis patients are required to restrict hand washing to prevent skin dryness
- The dialyzer membrane allows bacteria from dialysate to freely enter the bloodstream
Correct answer: Frequent vascular access cannulation, immunosuppression from uremia, and repeated exposure to healthcare environments
Dialysis patients have impaired immune function due to uremia, repeated needle punctures creating infection entry points, and multiple weekly healthcare contacts increasing exposure. These factors combine to make CRBSI and access infections major causes of morbidity and mortality.
Dialysis patients have impaired immune function due to uremia, repeated needle punctures creating infection entry points, and multiple weekly healthcare contacts increasing exposure. These factors combine to make CRBSI and access infections major causes of morbidity and mortality.
Question 2: What is the most effective single intervention for preventing healthcare-associated infections in a dialysis unit?
- Hand hygiene with soap and water or alcohol-based hand rub before and after patient contact (Correct answer)
- Wearing a surgical mask at all times in the dialysis unit
- Changing gloves between dialysis machines without hand washing
- Administering prophylactic antibiotics to all dialysis patients monthly
Correct answer: Hand hygiene with soap and water or alcohol-based hand rub before and after patient contact
Hand hygiene is the cornerstone of infection prevention. The WHO 5 Moments for Hand Hygiene apply: before patient contact, before aseptic tasks, after body fluid exposure, after patient contact, and after contact with patient surroundings.
Hand hygiene is the cornerstone of infection prevention. The WHO 5 Moments for Hand Hygiene apply: before patient contact, before aseptic tasks, after body fluid exposure, after patient contact, and after contact with patient surroundings.
Question 3: What is the CDC's recommended approach for surface disinfection in dialysis units between patients?
- Clean all external surfaces of the dialysis machine and chair with an EPA-registered disinfectant between each patient use (Correct answer)
- Wipe visible blood only; routine disinfection is not required between stable patients
- Use sterile water only to avoid chemical contact with patients
- Disinfect surfaces with 70% ethanol, which does not require EPA registration
Correct answer: Clean all external surfaces of the dialysis machine and chair with an EPA-registered disinfectant between each patient use
CDC and CMS require EPA-registered hospital disinfectant cleaning of all external machine surfaces, chair, and patient-contact areas between every patient. This includes the blood pump housing, touchscreen, armrests, and IV poles.
CDC and CMS require EPA-registered hospital disinfectant cleaning of all external machine surfaces, chair, and patient-contact areas between every patient. This includes the blood pump housing, touchscreen, armrests, and IV poles.
Question 4: Hepatitis B virus (HBV) poses a special risk in dialysis units because:
- HBV can survive on surfaces for up to 7 days and is highly infectious, making environmental contamination a significant transmission route (Correct answer)
- HBV is transmitted through the dialysate and cannot be filtered by standard dialyzer membranes
- All dialysis patients are immunocompromised and cannot be vaccinated against HBV
- HBV requires only casual contact for transmission and spreads rapidly in shared spaces
Correct answer: HBV can survive on surfaces for up to 7 days and is highly infectious, making environmental contamination a significant transmission route
HBV is an extremely hardy virus that survives on contaminated surfaces for up to 7 days at room temperature. In dialysis units, blood contamination of surfaces, equipment, and supplies makes environmental cleaning critical. HBV-positive patients must be treated in separate rooms/machines.
HBV is an extremely hardy virus that survives on contaminated surfaces for up to 7 days at room temperature. In dialysis units, blood contamination of surfaces, equipment, and supplies makes environmental cleaning critical. HBV-positive patients must be treated in separate rooms/machines.
Question 5: What is the correct order of donning (putting on) personal protective equipment (PPE) when preparing to assist a dialysis patient with an active wound infection?
- Gown first, then mask/eye protection, then gloves last (Correct answer)
- Gloves first, then gown, then mask
- Mask first, then gloves, then gown
- The order does not matter as long as all PPE is worn
Correct answer: Gown first, then mask/eye protection, then gloves last
The correct donning sequence is: gown → mask/respirator → eye protection/face shield → gloves. This ensures that hand contamination from gloves does not contaminate face protection, and the gown is secured before gloves are placed.
The correct donning sequence is: gown → mask/respirator → eye protection/face shield → gloves. This ensures that hand contamination from gloves does not contaminate face protection, and the gown is secured before gloves are placed.
Question 6: A dialysis patient is diagnosed with active pulmonary tuberculosis (TB). What isolation precautions are required?
- Airborne precautions: N95 respirator for staff, negative pressure room, and patient to wear surgical mask when outside their room (Correct answer)
- Contact precautions only: gown and gloves for all patient interactions
- Standard precautions are sufficient since dialysis patients are already immunocompromised
- Droplet precautions: surgical mask for staff within 3 feet of the patient
Correct answer: Airborne precautions: N95 respirator for staff, negative pressure room, and patient to wear surgical mask when outside their room
Pulmonary TB requires airborne precautions because M. tuberculosis is transmitted by airborne droplet nuclei. An N95 (or higher) respirator must be worn by staff, and a negative pressure isolation room is required. Dialysis units must have an emergency protocol for TB patients.
Pulmonary TB requires airborne precautions because M. tuberculosis is transmitted by airborne droplet nuclei. An N95 (or higher) respirator must be worn by staff, and a negative pressure isolation room is required. Dialysis units must have an emergency protocol for TB patients.
CHBT Infection Control in Dialysis Units 1
Why are dialysis patients at significantly higher risk for bloodstream infections compared to the general population?