The establishment of standardized operating procedures for the prevention and control of cross-infection, especially the spread of infectious diseases such as viral hepatitis B and hepatitis C among hemodialysis patients, to achieve the purpose of preventing and controlling the spread of infectious diseases in hemodialysis rooms (centers).
I. Basic facilities requirements for infection control in blood purification rooms (centers)
1. Structure and layout of blood purification rooms (centers)
See the chapter on structure and layout of blood purification rooms (centers).
2. Hand hygiene equipment for medical staff, including sinks, non-contact faucets, disinfectant hand sanitizers, quick-drying hand sanitizers, and hand-drying items or equipment, shall be provided in the hemodialysis treatment area.
3. Adequate personal protective equipment for staff, such as gloves, masks, and coveralls, shall be provided.
4. Hepatitis B and C patients must be separated into separate machines for isolated dialysis, machines in infected areas cannot be used for the treatment of non-infected patients, and should be equipped with specialized dialysis operating supplies carts for infected patients.
5. Nursing staff should be relatively fixed, and nursing staff caring for patients with hepatitis B and hepatitis C cannot care for patients who are negative for hepatitis B and hepatitis C at the same time.
6. Equipment and items used by infected patients such as charts, sphygmomanometers, stethoscopes, treatment carts, and machines should be labeled.
7. HIV-positive patients are advised to go to a designated hospital for dialysis or switch to peritoneal dialysis.
II. Preparation before treatment
1. For patients on dialysis for the first time or patients transferred from other centers must be examined for hepatitis B, hepatitis C, syphilis and HIV infection before treatment. For HBV antigen-positive patients should be further tested for HBV-DNA and liver function indicators; for HCV antibody-positive patients, further tests for HCV-RNA and liver function indicators should be performed, and the original records should be kept to register the patients' examination results. Delete: start
2. Inform patients that hemodialysis may bring about blood-borne infectious diseases, and ask them to comply with the relevant regulations of the blood purification room (center) regarding the control of infectious diseases, such as disinfection and isolation, regular monitoring, etc., and to sign the informed consent for dialysis treatment, and patients with dialyzers reused should sign the informed consent for dialyzer reuse at the same time.
3. Establishing patient files and clearly identifying hepatitis B and C patients in schedules, medical records and related documents.
Three, staff dress and wear personal protective equipment
1. Staff enter the blood purification room (center) through a special staff passage. Change into clean and tidy working clothes in the changing room.
2. When entering the work area, they should wash their hands first and wear personal protective equipment (PPE), such as gloves, masks, and coveralls, according to work requirements.
3. Staff operations should strictly follow the requirements of hand hygiene, wear personal protective equipment.
4. Gloves should be worn when handling medical dirt or medical waste, and hands should be washed after handling.
5. Staff handling reusable dialyzers should wear gloves, aprons, face masks and goggles.
Four, staff hand hygiene
Medical staff in the operation should strictly abide by the relevant medical staff hand hygiene norms issued by the Ministry of Health of the People's Republic of China **** and the State in 2009. In the dialysis operation to do the following: Delete: see appendix
1. Staff should wash their hands before and after contact with the patient or wipe their hands with rapid hand disinfectant.
2. Staff should wear gloves when touching patients or surfaces of potentially contaminated objects in the dialysis unit, and remove gloves when leaving the dialysis unit.
3. Staff shall wash their hands or wipe their hands with a quick hand sanitizer before and after performing the following operations, and shall wear masks and gloves when performing these operations: deep venous cannulation, venipuncture, injection of medications, blood draws, handling of blood specimens, handling of cannulae and access sites, handling of wounds, and handling or cleaning of dialysis machines.
4. Wash hands or wipe hands with rapid hand sanitizer and change gloves when touching different patients, entering different treatment units, or cleaning different machines.
5. Hand washing or hand rubbing with rapid hand disinfectant should be emphasized in the following cases: after removing personal protective equipment; before starting or after finishing an operation; when moving from a contaminated part of the same patient to a clean part; before and after contacting a patient's mucous membranes, broken skin, and wounds; after contacting a patient's blood, bodily fluids, secretions, excretions, and wound dressing; and after touching contaminated items.
V. Transfer of therapeutic articles
1. The nurse prepares therapeutic articles according to therapeutic needs in the treatment room (dialysis preparation room) and puts the necessary articles into the treatment cart; the articles brought into the treatment unit should be necessary for the treatment and conform to the requirements of cleansing or disinfection.
2. Treatment carts are not to be used in infectious or non-infectious areas.
3. Items belonging to patients in infectious areas cannot be brought into non-infectious areas.
4. Heparin cannot be injected into different patients with the same syringe or heparin sealing of deep vein cannulae.
6. Disinfection of dialysis machine
(1) Disinfection of the outside of dialysis machine
1. At the end of each dialysis, if there is no visible contamination, the outside of the dialysis machine should be disinfected initially, and 500mg/L chlorine-containing disinfectant or other effective disinfectant should be used to disinfect the machine by wiping.
2. If the blood contaminates the dialysis machine, the blood should be removed immediately by wiping with a disposable cloth containing chlorine disinfectant at a concentration of 1500 mg/L, and then the exterior of the machine should be disinfected by wiping with a chlorine disinfectant at a concentration of 500 mg/L.
(2) Disinfection inside the machine
1. At the end of each dialysis, the internal pipeline of the machine should be disinfected according to the requirements of the instruction manual of the dialysis machine. Disinfection methods should be referred to the instruction manuals of different dialysis machines.
2. If membrane rupture occurs during dialysis, and the protective cover of the arterial and venous sensors leaks, the machine should be disinfected immediately at the end of dialysis, and the disinfected machine can be used again only after disinfection.
Seven, the use of dialysis consumables disinfection
(a) the strict implementation of the State Food and Drug Administration (SFDA) on the disposable items related to the system. Only the reusable dialyzers/hemofilters approved by SFDA can be reused, and the reuse must follow the "Code of Practice for Reuse of Hemodialyzers" formulated by the Ministry of Health.
(2) Dialyzer lines and needles cannot be reused.
(3) Patients with hepatitis B virus, hepatitis C, HIV and syphilis infection are not allowed to reuse dialyzers/hemofilters.
(4) The specific operating procedures for reuse of dialyzers/hemofilters refer to the content of "reuse of dialyzers and quality control".
(e) Disposable items should be disposed of according to the requirements of medical waste disposal after being used for one patient.
VIII, air and surface disinfection
Refer to the "hemodialysis center infection control management requirements" content.
Nine, medical filth and waste disposal
Refer to the "hemodialysis center infection control management requirements" content.
X. Infection control monitoring
1. Surface and air monitoring of dialysis treatment room objects Monthly culture monitoring of pathogenic microorganisms in the air of the dialysis treatment room, objects, surfaces of machines and the hands of some medical staff, keeping original records and establishing a register.
2. Surveillance of infectious disease pathogenic microorganisms in dialysis patients
(1) New patients who start dialysis for the first time or patients transferred from other centers must be examined for Hepatitis B, Hepatitis C, syphilis and HIV infection before treatment. For HBV antigen-positive patients should be further tested for HBV-DNA and liver function indicators, and for HCV antibody-positive patients, HCV-RNA and liver function indicators should be further tested. Keep the original records to register the patients' test results.
(2) Patients on long-term dialysis should be examined for hepatitis B and C viral markers at least once every 6 months; original records should be kept and registered.
(3) Quantitative HBV-DNA and HCV-RNA tests should be performed for hemodialysis patients in the presence of unexplained abnormal elevation of liver transaminases.
(4) Hepatitis B and C marker tests should be performed immediately on close contacts if any patient becomes hepatitis B or C positive during dialysis.
(5) For patients suspected of possible hepatitis B or C infection, if the viral test is negative, the viral marker test should be repeated 1 to 3 months thereafter.
3. Hepatitis B vaccination is recommended for hepatitis B-negative patients.
Eleven, medical staff infection monitoring and prevention
1. Staff should know and follow the infection control system and norms of blood purification room (center).
2. Hepatitis B and C markers should be monitored regularly for blood purification center staff. Hepatitis B vaccination is recommended for hepatitis B negative staff.
3. After the staff encountered needle-stick injury
(1) Emergency treatment: gently squeeze the wound, squeeze out as much blood as possible from the injury, and then rinse it with running water (mucous membranes are rinsed repeatedly with saline), and then disinfect it with disinfectant solution (e.g., 75% alcohol) and bandage the wound.
(2) Fill in the "Medical Staff Occupational Exposure Registration Form" and submit it to the hospital infection management office for record.
(3) Being stabbed by HBV or HCV positive patient's blood, body fluids contaminated sharps, it is recommended to inject Hepatitis B immune high-value globulin within 24 hours, and at the same time to conduct a blood test for Hepatitis B markers, the negative person in the following one to three months and then check, and is still negative can be given to give subcutaneous injection of Hepatitis B vaccine.
Twelve, infectious disease report
Hemodialysis units (centers) found that the new hepatitis B, hepatitis C or other infectious diseases should be reported to the relevant departments in accordance with the national reporting system of infectious diseases.