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Monday, December 13, 2010

Dialysis Patient And Staff Safety

After completing this module, the learner will be able to:
1. Describe the predialysis set-up of the hemodialysis machine and extracorporeal circuit.
2. Explain the start, monitoring, and end of a routine treatment.
3. Identify the vita) signs that should be monitored before, during, and after treatments.
4. Discuss the basics of infections control.
5. Explain how to draw up and give intravenous medications.
6. Describe how to draw a blood sample.
7. Discuss the importance of documenting patient care.
8. Identify the causes, signs and symptoms, and prevention of clinical and technical complications that may occur during

Introduction for Patient And Staff Safety

• Cleaning a patient's blood with dialysis is a complex process with many steps - and each step may be crucial to keeping patient safe and maintaining their comfort.
• Dialysis treatments can only be uncomplicated and routine when staff pay close attention.
• This module covers the types of patient care tasks, technical tasks, and skills you will need to learn to
deliver safe and effective treatment.
• It goes over the processes of dialysis, from set-up to clean-up.

Patient and Staff Safety


• When you use good body mechanics (moving your body to prevent), you can avoid muscle strain and fatigue.
• Awkward postures, repetitive motion and heavy lifting are three main risk factors in musculoskeletal injury.
• To move effectively, you need to make friction, leverage, and gravity work for you.

Lifting and Carrying
• The proper way to lift objects - like supply boxes -is to stand with your feet shoulder-width apart and bend from your hips and knees.
Never bend at the -waist or turn your body -when you lift, push, or pull an object.
• Put your hands around the object and pick it up, holding it close to your body.
• Bend your knees and keep your back straight; you want to use your arm and leg muscles - not your back.
• If the object is too heavy for you to lift by yourself, don't try it - get help instead.

Back-saving Tips
• Think before you lift.
• Lift with your legs and hold the object close to your body.
• Start at your ideal body weight.
• Strengthen your leg and stomach muscles.
• Exercise for 30 minutes, at least 3-4 times a week. Improve your flexibility; do gentle stretches every day.
• Never twist and lift at the same time. Keep your feet, knees, and torso pointed in the same direction.
• Test the weight of the object or patient before you lift. If something is too heavy, get help from a co-worker or a mechanical aid.
• Push, don't pull. You'll have twice as much power and less chance of injury.
• Slow smooth movements are safer than fast, jerky ones.
• If you develop back pain, stop what you are doing. Patient and Staff Safety

• Which technique you use will vary with how well a patient can stand up and bear his/her own weight. • Before you move a patient, check his/her general condition.
• If possible, do not move a patient who has unusual fatigue, nausea, or unstable pulse or blood pressure; an unstable patient may fall.

Patients Who Use Walkers
• You may need to help patients who use walkers to be sure they can balance and will not fall.
• Even though it may be faster for you to put a patient in a wheelchair, it is physically better for the patient to use the walker

Chair-to-Chair Transfers
 • Lock the wheelchair and apply breaks anytime you move a patient to or from a wheelchair.
• Even with the breaks on, hold the wheelchair in place or put one foot against a wheel during a transfer to keep it from slipping or tipping over

Stand and pivot technique
     • Help the patient sit on the edge of the chair.
     • Put a gait belt (heavy canvass belt) around the patient's
waist to provide stability and control during the transfer.
     • Stand in front of the patient and help him/her to stand by pulling the belt to bring the patient toward you.
     • Then, slowly pivot with the patient until you can lower the patient into another chair and then remove the belt.
     • Use good body mechanics to prevent injury.

Using a slide board (from the sitting position)
     • Hold the board steady during the transfer.
     • Lock the wheelchair and hold onto it during the transfer.
     • Have a "spotter" standing by - someone who can help the patient to the floor if he/she slip or the board moves.
     • Ask a staff to hold the dialysis chair to keep it from
moving during the transfer.

Portable lift devices
• Portable lift devices like Hoyer™ lifts or sling lifts are usually used for patients who can't bear weight, are very heavy, or can't help with their own transfers,
• Make sure the device will hold the weight of the patient you are moving before you try a transfer (the weight limit will be in the owner's manual).
• Patient transfers using portable lift devices require at least two staff members.
     • One to move the lift
     • One to pull the patient to the correct part of the chair.
• When you see a portable lift device;
     • Make sure the sling is under the patients body from shoulder to hips.
     • Check the hooks are all in the correct slots on the sling holder,
     • Raise the patient up just enough to clear the chair.
     • Be sure the patient's fingers are clear of any hooks that could pinch.
     • Release the patient down into the chair gently
     • Reposition the patient as needed.

Stretcher-to-Chair Transfers
• If a patient can bear some weight, place the stretcher in a low position and use the stand and pivot technique.
• If the patient can't bear weight, use a portable lift device.

Stretcher-to-Bed (Lateral) Transfers
• Lateral transfers are used for bed-bound patients.
• You can use assist devices, like sheets or board with rollers, to help push and pull a patient from a stretcher to a bed.
• You will need several staff, but these devices avoid the need for a complete lift, which reduces the risk of injury.
• For all lateral moves, the surface to which the patient is being transferred should be a half inch
lower than the surface the patient is on.
• Using an assist device, some of the staff members will push and the others will pull the patient onto the new surface.

• An emergency is an unexpected event, like a fire, tornado, hurricane, flood, blizzard, ice storm, or earthquake, that requires help or immediate action.
• Key points of emergency preparedness include:
     • Follow your center's plan to notify staff and emergency services personnel.
     • Know where to find all exit doors, how to locate arid use fire extinguishers, and your role if there is an emergency.

In case of fire, remember R.A.C.E:
     • Rescue
     • Activate the alarm
     • Contain the fire (only if small)
     • Evacuate

To use a fire extinguisher, remember P.A.S.S.:
     • Pull the pin
     • Aim the nozzle at the base of the flame*
     • Squeeze the handle
     • Spray from side to side at the base of the flames

• Disconnect patients from the machine to evacuate in this order.
     1. Patients who can walk without help
     2. Patients who can walk, but will need some staff help to do so
    3. Patients who cannot walk and will need staff help to evacuate
• Evacuate the premises using the safest and closest exit.

• Pathogens (agents that cause disease, like bacteria, virus, or fungi) that invades the body can cause infection.
• Infectious disease is the second most common cause of death in dialysis patients.
• The most common pathogens normally live on the skin and on mucous membranes, (e.g., lining of the nose, mouth, and bowels). Others are found in the soil, in water, on clothing, and on all surfaces.
• Communicable disease can be spread in several ways:
     l. Direct contact: touching an infected person, such as
shaking hands or kissing.
     2. Indirect contact: touching contaminated objects such as clothing, towels, cups, water faucets, telephones, doorknobs and equipment
     3. Droplet spread: breathing in sneezed or coughed droplets from the nose, mouth, throat, or lungs of an infected person

• Infection can also occur when contaminated fluids enter the body such as through a needle stick.
• A bite of an insect can cause disease.
• Some diseases are caused by breathing in airborne fungi, bacteria, or viruses in dust or lint.
• In a dialysis center, pathogens can be spread by patients, staff, visitors, equipment, water, dialysate, and air.

Aseptic Technique
• Aseptic (free from infection) technique is used to keep an object or area sterile (free from all germs).
• Other terms that relate to aseptic technique are:
     • Clean: not free of germs, but disinfected and usable for some steps in the treatment
     • Contaminated: an object that was sterile, but then was touched by a non-sterile object (germs could now be on the object)
     • Dirty: neither clean nor sterile, cannot be used for dialysis steps that require an object to be clean or sterile

Guidelines for Aseptic Technique
• Prepackaged sterile items are sterile only if the package is closed and intact. Open sterile solutions or supplies only when you need them. Once open, they are exposed o airborne pathogens.
•  Wash your hands before you touch a package that contains a sterile item. This will help keep you from getting germs on the item. Packages that contain sterile items should not be allowed to get wet -moisture allows pathogens to pass through the wrapper and contaminate the object,
•  A contaminated object contaminates a sterile object. For example, when you spike a bag of saline, take care to insert the spike directly into the port. If the spike touches the outside of the bag or any other unsterile object, it becomes contaminated itself, and you cannot use it.
• Before you use a multidose vial, scrub the rubber stopper with disinfectant. Mark the vial with the date and time of first use.
• All fistula needles, syringes tips, and needles used to give medications or draw blood must be sterile, because they enter the bloodlines or the patient's body. When you start a treatment, do not touch the fistula needle or ends of the bloodlines to the patient or dialyzer. When you attach a heparin syringe to the heparin line, do not touch the syringe tip or the end of the heparin line.

Hemodialysis Infection Control Precautions
• Ways to prevent bloodbome infections in HD patient as recommended by the Center for Disease Control and Prevention (CDC).
• Components of dialysis precautions
     • Wash hands before and after removing gloves, or after exposure to body fluids.
     • Place infectious waste in color-coded receptacles.
     • Store properly
• Components of dialysis precautions
     • Clean all work surfaces.
     • Never mix food and medical supplies in the same refrigerator.
     • Maintain accurate records
     • Wear employee protective clothing, like gowns, masks, goggles and gloves.
     • Use sharps box.

• Washing your hands correctly is the single most important thing you can do to prevent the spread of infection.
• It protects you as well as the patient.
• The goal is to remove pathogens that might be transferred to patients, visitors, or other staff.
• Research shows that handwashing can reduce infection
rates, stop an outbreak of disease, and reduce the spread of drug-resistant bacteria,

When to Wash Your Hands
• Between contact with all patients
• Before and after you do any invasive procedures - like putting in dialysis needles - even if you wear sterile gloves
• Before you touch a wound, whether it is surgical, due to trauma, or caused by an invasive device - like a dialysis needle.
• Before you touch patients who have diseases that make them more susceptible to infection
• After you touch any body substance or mucous membrane •
• After you take off your gloves
• Between tasks and between procedures on the same patient to prevent cross contamination of different body sites
• When you enter and leave the center, to reduce the chance of spreading germs to your family, the patients, and other staff.

• CDC recommends:
     • That when you wash your hands with soap and water, wet your hands first with water.
     • Apply the amount of soap recommended by the manufacturer, and rub hands together briskly for at least 15 minutes, covering all surfaces of the hands and fingers.
     • Rinse your hands with water and dry thoroughly with a paper towel
     • Use a paper towel to turn off the faucet •
     • CDC also recommends that healthcare personnel who have direct contact with high risk patients - which includes dialysis patients - avoid wearing artificial nails. Keep your nails less than one quarter of an inch long.
     • If your hands are not visibly dirty, you can use an alcohol-based handrub.
     • Apply the product to the palm of one hand and rub your hands together to cover all surfaces until your hands are dry.
     • Always wash your hands with either soap or an alcohol-based handrub if your hands are not visibly dirty; after you take off gloves; each time you work with a different patient; and after you touch blood, body fluids and contaminated items.
     • Use hand lotion or cream after washing your hands to „ prevent dryness and chapping.

Protective equipment
• During a treatment, you can be exposed to blood and contaminated items.
• You must wear gloves when you care for a patient or touch the equipment.
• You must also change your gloves between patients -failing to change gloves is a common error made in heallhcare settings.

Change your gloves:
• After each patient contact
• When they are bloodstained
• After you handle infectious waste containers
• After starting a treatment
• Before you touch any surface such as machine dials, charts, and phones.

When to Use Protective Equipment

• When you do tasks that may cause blood or body fluid to splash or spray (e.g., start and end of a treatment, injecting into a bloodline, putting in needles).
• When you handle patient care equipment that is soiled with blood or body fluids, to prevent contamination of clothing or skin.

Wear a face shield and protective eyewear:
• During tasks that may cause droplets of blood or body fluids to splash or spray
• At the start and end of a treatment <> When troubleshooting the vascular access
• When you inject into the bloodlines or change the transducer protector

To avoid sticking yourself with sharps (needles):
•  Never recap needles if at all possible. If, for some reason, you must recap, use a mechanical recapping device or a one-handed method.
• Do not bend, shear, or break contaminated needles.
• Dispose of needles in puncture-resistant, color-coded boxes.
• Always point needles away from yourself.

Protective equipment
• Steps to properly remove gloves:
     1. With both hands gloved, peel one glove off from the top (wrist) to the bottom (fingers) and hold it in the gloved hand.
     2. With the exposed hand, peel the second glove off from the inside, tucking the first glove inside the second.
     3. Do not "snap" the gloves when you take them off. Throw out the soiled gloves promptly
Wear a gown:

Dialysis Patient And Staff Safety - Related Hemodialysis Article


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