Establish standardized operating procedures to prevent and control cross infection, especially the spread of infectious diseases such as viral hepatitis B and hepatitis C among hemodialysis patients, and prevent and control the spread of infectious diseases in blood purification rooms (centers).
First, the blood purification room (center) infection control infrastructure requirements
1. Structure and layout of blood purification room (center)
See the chapter on structural arrangement of blood purification room (middle).
2. The hemodialysis treatment area should be equipped with hand hygiene equipment for medical personnel, including pools, non-contact faucets, hand sanitizers, quick-drying hand disinfectants, hand drying items or equipment.
3. Should be equipped with enough personal protective equipment, such as gloves, masks, work clothes, etc.
4. Patients with hepatitis B and hepatitis C must be isolated and dialyzed by the expansion unit. Machines in infected areas cannot be used for the treatment of non-infected patients, and infected patients should be equipped with special dialysis operation supplies vehicles.
5. Nurses should be relatively fixed. Nurses who care for patients with hepatitis B and hepatitis C cannot care for patients with negative hepatitis B and hepatitis C at the same time.
6. Equipment and articles used by infected patients, such as medical records, sphygmomanometers, stethoscopes, therapeutic vehicles and machines, should be marked.
7. It is suggested that HIV-positive patients go to designated hospitals for dialysis or peritoneal dialysis.
Second, the preparation before treatment
1. Patients who receive dialysis for the first time or are transferred from other centers must be tested for hepatitis B, hepatitis C, syphilis and AIDS infection before treatment. For patients with positive HBV antigen, HBV-DNA and liver function indexes should be further detected; For HCV antibody positive patients, HCV-RNA and liver function indexes should be further detected, and the original records should be kept to register the patient's examination results. Delete: start
2. Inform patients that hemodialysis may bring blood-borne infectious diseases, and ask patients to abide by the relevant regulations of blood purification room (center) on infectious disease control, such as disinfection and isolation, regular monitoring, etc. , and sign the informed consent of dialysis treatment. Patients who reuse dialyzers should also sign an informed consent form for reuse dialyzers.
3. Establish patient files, and clearly identify patients with hepatitis B and hepatitis C in shift tables, medical records and related documents.
Three, the staff dress and personal protective equipment to wear
1. Staff enter the blood purification room (center) through the special staff passage. Change into clean and tidy work clothes in the locker room.
2. When entering the work area, you should wash your hands first and wear personal protective equipment, such as gloves, masks and work clothes, according to the work requirements.
3. The staff should strictly abide by the requirements of hand hygiene when operating, and wear personal protective equipment.
4. Wear gloves when handling medical dirt or medical waste, and wash your hands after handling.
5. Operators of the multiplex dialyzer should wear gloves, aprons, masks and goggles.
Fourth, staff hand hygiene.
Medical staff should strictly abide by the "Hand Hygiene Standard for Medical Staff" issued by the People's Republic of China and the Ministry of Health in 2009. Perform the following operations during dialysis operation: Delete: See Appendix.
1. Staff should wash their hands or wipe their hands with quick hand disinfectant before and after contact with patients.
2. Workers should wear gloves when contacting patients or surfaces that may be contaminated in the dialysis unit, and take off gloves when leaving the dialysis unit.
3. The staff should wash their hands or wipe their hands with quick hand disinfectant before and after the following operations, and wear masks and gloves when operating: deep vein intubation, venipuncture, drug injection, blood drawing, blood sample processing, intubation and channel processing, wound processing, dialysis machine processing or cleaning.
4. When contacting different patients, entering different treatment units and cleaning different machines, wash or wipe hands with quick hand disinfectant and change gloves.
5. In the following situations, the quick hand disinfectant should be used to wash or wipe hands: after taking off personal protective equipment; Before or after surgery; When moving from a contaminated part of the same patient to a clean part; Contact with the patient's mucosa, damaged skin and wound before and after; After contact with the patient's blood, body fluids, secretions, excreta and wound dressing; After contact with contaminated items.
Verb (abbreviation for verb) Transshipment of therapeutic goods.
1. The nurse prepares the treatment items in the treatment room (dialysis preparation room) according to the treatment needs, and puts the required items into the treatment cart. Articles brought into the treatment unit should be necessary for treatment and meet the requirements of cleaning or disinfection.
2. The therapeutic vehicle cannot be used in infected and non-infected areas.
3. Do not bring the articles of patients in the infected area into the non-infected area.
4. You can't inject heparin into different patients with the same syringe, and you can't seal the deep venous catheter with heparin.
Six, dialysis machine disinfection
(1) external disinfection of dialysis machine
1, after each dialysis, if there is no pollution visible to the naked eye, the exterior of the dialyzer should be preliminarily disinfected first, and then wiped and disinfected with 500mg/L chlorine-containing disinfectant or other effective disinfectants.
2, if the blood pollution to the dialysis machine, should immediately use 1500 mg/L concentration of chlorine disinfectant disposable cloth to wipe off the blood, and then use 500 mg/L concentration of chlorine disinfectant to wipe and disinfect the outside of the machine.
(2) Disinfection inside the machine
1. At the end of each dialysis, the internal pipes of the dialysis machine should be disinfected according to the requirements of the operating instructions of the dialysis machine. The disinfection method refers to the operating instructions of different dialyzers.
2. In case of membrane rupture and leakage of protective cover of arteriovenous sensor during dialysis, the machine should be disinfected immediately after dialysis, and the disinfected machine can be used again.
Seven, dialysis consumables use disinfection treatment
(1) Strictly implement the relevant regulations of the State Food and Drug Administration (SFDA) on disposable products. Reusable dialyzers/blood filters approved by the Food and Drug Administration of the United States can only be reused, and the reuse must be carried out in accordance with the Operating Specification for Reuse of Hemodialyzers formulated by the Ministry of Health.
(2) The dialyzer pipe and puncture needle cannot be reused.
(3) Patients infected with hepatitis B virus, hepatitis C virus, HIV and syphilis shall not reuse dialyzers/blood filters.
(4) Refer to "Dialyzer Reuse and Quality Control" for specific operation procedures of dialyzer/hemofilter reuse.
(5) After disposable goods is used for patients, it shall be treated according to the requirements of medical waste treatment.
Eight, air and surface disinfection.
See "Management Requirements for Infection Control in Hemodialysis Center".
Nine, medical dirt and waste treatment
See "Management Requirements for Infection Control in Hemodialysis Center".
X. Monitoring of infection control
1. Monitoring of object surface and air in dialysis treatment room. Monitor the culture of pathogenic microorganisms in the air, objects, machine surfaces and hands of some medical staff in dialysis treatment room every month, keep original records and establish registration forms.
2. Monitoring of pathogenic microorganisms of infectious diseases in dialysis patients.
(1) Before treatment, new patients who start dialysis for the first time or patients transferred from other centers must be tested for hepatitis B, hepatitis C, syphilis and AIDS infection. For patients with positive HBV antigen, HBV-DNA and liver function indexes should be further detected, and for patients with positive HCV antibody, HCV-RNA and liver function indexes should be further detected. Keep the original records and register the patient's examination results.
(2) Long-term dialysis patients should check HBV and HCV markers 1 time at least every 6 months; Keep original records and register.
(3) HBV-DNA and HCV-RNA should be detected quantitatively when liver transaminase is abnormally increased in hemodialysis patients.
(4) If patients are positive for hepatitis B and hepatitis C during dialysis, the markers of hepatitis B and hepatitis C should be detected immediately for close contacts.
(5) For patients suspected of being infected with hepatitis B or hepatitis C, if the virus test is negative, the virus marker/kloc-0 should be repeatedly tested for ~ 3 months.
3. It is suggested that hepatitis B vaccine should be given to patients with negative hepatitis B. ..
Eleven, medical staff infection monitoring and prevention.
1. The staff should master and abide by the infection control system and norms of the blood purification room (center).
2. The staff of the blood purification center should regularly monitor the markers of hepatitis B and hepatitis C. For employees with negative hepatitis B, it is recommended to inject hepatitis B vaccine.
3. After the staff encountered the needle injury,
(1) First-aid treatment: squeeze the wound gently, squeeze out the blood from the injured part as much as possible, then wash it with running water (wash the mucosa repeatedly with normal saline), and then disinfect and bandage the wound with disinfectant (such as 75% alcohol).
(2) Fill in the Registration Form for Occupational Exposure of Medical Staff and submit it to the Hospital Infection Management Office for the record.
(3) Patients with 3)HBV or HCV positive were stabbed by sharp instruments contaminated by blood and body fluids. It is suggested to inject hepatitis B immunoglobulin within 24 hours and check the blood markers of hepatitis B. Those who are negative should be checked again in 1 ~ 3 months. If they are still negative, they can be given subcutaneous injection of hepatitis B vaccine.
Twelve. infectious disease notification
Hemodialysis room (center) found new hepatitis B, hepatitis C or other infectious diseases should be reported to the relevant departments in accordance with the relevant national infectious disease reporting system.