>> Welcome to the first segment of the frontline staff toolkit
for outpatient hemodialysis facilities.
This toolkit was created as a resource for frontline staff
who are having frequent interactions and providing direct care
in outpatient hemodialysis facilities.
It includes brief video slide decks intended to be used as educational resources.
They can be viewed as a group or individually as time allows.
Evidenced-based practices and existing CDC guidance for preventing infections
in the dialysis setting as well as observations
of clinical practice are the foundations of this toolkit.
COVID-19 recommendations are summarized in the interim additional guidance
for infection prevention and control recommendations for patients with suspected
or confirmed COVID-19 in outpatient hemodialysis facilities.
This guidance was developed from the information currently available about COVID-19.
This approach will be refined and updated as more information becomes available
and as response needs change in the United States.
It is important to stay informed about COVID-19 to prevent introduction and minimize the spread
of COVID-19 in your dialysis facility.
We encourage you to use this toolkit along with other COVID-19 dialysis-specific resources
in ongoing activities in your clinic.
The guidance and additional resources are available on CDC's webpage.
The video you are watching is infection prevention basics:
tips for outpatient hemodialysis facilities, hand hygiene, and environmental disinfection.
We will start with a quick review of these two basic topics
since these are things you do every day to keep patients safe and prevent infections.
They are also essential to prevent the spread of COVID-19.
So, let's get started.
One of the most important things we can do to prevent the spread of germs to ourselves
and others is perform hand hygiene.
You can perform hand hygiene by using either soap and water
or alcohol-based hand sanitizer containing at least 60% alcohol.
Hand sanitizer is preferred unless your hands are visibly soiled.
Using the right amount of hand sanitizer should allow your hands
to stay wet for around 20 seconds.
When your hands are visibly soiled with blood or other body fluids, wash them with soap
and water for at least 20 seconds.
Hand hygiene is essential at key moments during patient care.
As illustrated by this graphic, opportunities for hand hygiene include prior
to entering the dialysis station to provide patient care, prior to inserting, adjusting,
or removing cannulation needles, prior to aseptic procedures
such as performing catheter care, medication preparation, and medication administration,
after touching the patient surroundings within the patient station, after exposure to blood
or body fluids, and when moving between dialysis stations.
Remember gloves are not a substitute for hand hygiene
and your hands can still be contaminated when gloves are worn.
Hand hygiene should be performed before putting on gloves and immediately after removing gloves.
Moving on to our next topic.
What is environmental disinfection?
Environmental disinfection is a two-step process.
Step one, the cleaning step, removes organic matter and visible solids that could interfere
with the effectiveness of disinfection.
Step two, the disinfection step, eliminates most bacteria, viruses,
and fungi except bacterial spores on inanimate objects.
Routine disinfection is a term we hear and use often in dialysis.
This term describes when you disinfect the patient stations
between patients and at the end of the day.
You apply disinfectants to eliminate many
or all pathogenic microorganisms except bacterial spores.
We must remember, however, that routine disinfection only applies to surfaces
that are not visibly soiled with blood or other materials.
When visibly soiled, you must perform a cleaning step in addition to routine disinfection
to ensure the disinfection step is effective.
There are a few key points to remember when you think about
and perform routine disinfection of a dialysis station.
First, discard all single-use supplies, then make sure you follow your facility protocol
for disinfecting supplies that are reusable, such as clamps or tourniquets.
These items should be cleaned and disinfected in a separate area.
Make sure you apply disinfectant to all surfaces
within the patient station per the manufacturer's instructions for use.
The surfaces should be visibly wet and allowed to air dry.
This is important because it allows
for sufficient disinfectant contact time per the manufacturer's instructions.
And, finally, the most important thing to remember is
that you should not start the disinfection process until the patient has left the station.
Let's discuss some tips to remember.
During routine disinfection, don't forget to disinfect any reusable items
that may have been brought into the patient station during treatment.
Examples include thermometers or stethoscopes, remotes, or pH meters.
Discard unused medication or non-reusable supplies taken to the patient station.
Do not return them to a common clean area.
Examples include medication vials, skin antiseptic pads, or swabs.
Going beyond the patient stations, don't forget to clean and disinfect other surfaces
within your dialysis clinic on a regular schedule.
This could include items such as scales or other surfaces frequently touched by staff
and patients, waiting room areas and door handles, computers and phones, wall boxes,
and biohazard or sharps containers.
The routine cleaning and disinfection procedures that we've discussed so far are all appropriate
for COVID-19 in dialysis settings.
As long as you use an Environmental Protection Agency, or EPA, registered disinfectant
that is designated for use against SARS-CoV-2, the virus that causes COVID-19.
The EPA has a list of these products, called List N, available on their website,
which is on the slide, or you can find a link to this list on the CDC website.
For dialysis, it is especially important
to ensure the product chosen has a bloodborne pathogen claim as well.
Any surfaces, supplies, or equipment located within six feet
of a symptomatic COVID-19 patient should either be disinfected
or discarded if it can't be disinfected.
Finally, remember you are part of a team.
Make sure you take the time to help each other out when it comes to hand hygiene
and disinfection practices at your facility.
If you notice someone isn't cleaning their hands properly,
speak up and have a conversation about it.
If you have a question, ask them.
Odds are someone else has a very similar question and can learn from your answer.
Working together and using your voice is the key to keeping yourself,
your coworkers, and dialysis patients safe.
For additional resources and training on the topics discussed in this presentation,
please check out CDC's Clean Hands Count website
and the dialysis safety infection prevention site,
which includes continuing education webinars on a variety of infection prevention topics.
Thank you for watching this module
and don't forget there are two additional modules in this series.