I work with a tech who works per diem for Fresenius. He told me that Fresenius changed their policy so that they will not start a new setup until the first patient is out of the chair. It has to do with the new Conditions for Coverage.

Is he correct? I don't see this working given the tight turn around times.

He is correct. If you setup for a new patient while another patient is in the chair, it is considered contaminated. Any item taken into the patients "space" is considered contaminated. You also must wear a glove to reset a machine alarm.

Is this just a Fresenius policy or is it written somewhere? If so, please post.

I heard this a few days ago from the clinic manager. She did say that Fresenius may do this because of the new "Conditions of Coverage" set by Medicare. It's all interpretation. We are not sure exactly what they will do yet. Still waiting.

it also has to do with the CDC infectious control programs. If the patient is still in the chair and begins to spray blood everywhere the system is (obviously) contaminated and cannot be used. This is also the reason you cannot store products (even sealed) behind machines or in close proximity to stations

I also heard that with the new CMS conditions for coverage they are strictly enforcing a 10 minute contact time for all contaminated surfaces with a disinfectant like 1% bleach. this means that when you wipe down a chair or machine it must sit there for 10 minutes before you can touch it again.

The chapter and verse of the IG for V122 is:

"Effective disinfection requires a minimum wet contact time of the disinfectant on the surface. Disinfection must adhere to the minimum duration of wet contact as specified by the product label; no patient should be at the station during that time."

The misuse of language belongs to the federal government and not me.

IG for V122:

For each “station” (i.e., the machine, the purified water connection, dialysate concentrate container(s) or connection(s), and the treatment chair), the completion of one patient's treatment and post-dialysis care must be separated by enough time from the initiation of the next patient’s care to allow correct disinfection. If the previous patient remains in the treatment chair while the machine is prepared for the next patient, extreme caution must be employed to prevent cross-contamination.

I can not find the manufacturer's recommended contact time for 1-100 bleach.

OK Dave - the other question that begs to be asked is: "Does the manufacturer have disinfection claims on the product"?

Since we are using household ultra bleach, I don't know what if any claims the manufacturer has.