Larry, Thank You!

Chuck

What do you make of E.4 when they talk about cleaning and or disinfecting between each treatment and disinfecting at the end of the day. There is more there you can read but I can't see the nurses adding an extra 2 hours to the day for disinfecting machines in an acute setting! Don't get me wrong, I dont think the
machines get disinfected enough as it is but I
have a hard time getting the staff to sign off on disinfections that were done just once a day.
Unless something has changed an 8k only keeps the last disinfection done in its memory which is very poor! sorry to ramble!
sk8

quote:

Originally posted by SK8:
What do you make of E.4 when they talk about cleaning and or disinfecting between each treatment and disinfecting at the end of the day. There is more there you can read but I can't see the nurses adding an extra 2 hours to the day for disinfecting machines in an acute setting! Don't get me wrong, I dont think the
machines get disinfected enough as it is but I
have a hard time getting the staff to sign off on disinfections that were done just once a day.
Unless something has changed an 8k only keeps the last disinfection done in its memory which is very poor! sorry to ramble!
sk8

Does your machine constantly have dialysate running through it or not?

This is what I make of it:

If your machine is connected to concentrate throughout the day (Kind of like Chronic) -The OUTSIDE of the machine needs to be cleaned/disinfected and the inside should be vinegar cleaned and rinsed between each treatment and disinfected at the END of that day.

If your machine is not always connected to a concentrate (Moved around the hospital station: station) - Your machines should be heated; bleached disinfected internally and externally before going to another room or patient.

They have to make this regulation because of the infectious control issues that are arising.

The thing that confuses me is this:
On the end of the sentence for continuous dialysate flow it says to clean it and disinfect it: "according to the manufacturer’s instructions". I don't understand why they would throw that line in there?

I think that all machines that stay in the same designated area for the day should not have to be cleaned/disinfected until the end of the day, but we don't make the regulations.

San Augustine,

I too am confused on how it reads. I think there needs to be some clarification. Wouldnt you have to disinfect after putting vinegar in the machine becuase it not a disinfectant? If a
machine was used and was left idle, no flow of
any kind because there may be a patient. This patient may come in 1, 2 or 5 hours, would it have to be disinfected for the 2nd patient of the day? On the same note why don't they require the machine to be disinfected before using it on the 1st patient. The machine may have been sitting for 2 hours or 36 hours?
Just a thought.
I do agree infection control is a big issue not
just for dialysis in an acute setting.

sk8

QUOTE] On the same note why don't they require the machine to be disinfected before using it on the 1st patient. The machine may have been sitting for 2 hours or 36 hours? [/QUOTE] Well as RD52 states, "each machine should at least be ran for 15 minutes a day".

quote:

Wouldnt you have to disinfect after putting vinegar in the machine becuase it not a disinfectant? If a
machine was used and was left idle, no flow of
any kind because there may be a patient.

No, you wouldn't have to disinfect the machine after a vinegar cleaning. You would have to put the machine through rinse to initiate another treatment. At the end of the day is when I would want to disinfect, just like a chronic unit.
Is the reason they make you disinfect between each treatment, if ambulatory, because of the unknown HB anti-bodies? Or in order to initate an ACUTE Tx, you would have to know the HB antibody status?

Larry, Chuck, or Stephen care to comment?

My interpretation....

"Provided that there is a continuous flow of dialysate through the machine, dialysis machines that are used to perform multiple treatments during the day should be cleaned following each treatment and disinfected at the end of the day according to the manufacturer’s instructions." To me this says that the machine needs to be stationary and continuously running with subsequent patients brought to the machine, not the machine to the patient.

"If there is no dialysate flow between treatments, the machine should be disinfected before a second treatment is performed." If you turn the machine off and take it to subsequent patients, it needs to be disinfected.

Now, my opinion (and rant)....

Some members of the AAMI committee (NOT Larry!) are idiots with unrealistic expectations. They have the attitude of if its possible to do....you must do it, whether it actually makes a difference or not. They defend themselves by saying they make reccomendation, not the regulations, all the while knowing that their "reccomendations" are adopted by reference as regulation by CMS (at least one of the members is actually from CMS).

Now some good news....The Conditions of Coverage were recorded in the Federal Register at least a year prior to this document being finalized so....It's NOT enforcable until the CoC's are updated again. Hopefully by then the zealots on the committee will come to their senses and make some "reccomendations" that can actually work in the real world!

::::climbing down off my soapbox::::

Chuck

PS...One day I'll tell you all how I really feel about AAMI.

For more information on endotoxin filters that filter to .005 micron try this site.
http://www.biologicalwaterfilt...is-water-filters.php

About the "divert to drain" clause, in the paragraph above that they are talking about using a deionizer polishing cartridge post RO if the water does not meet the quality requirements. Then just before mentioning the "divert to drain" it is noted that and exhausted deionizer may abruptly fail and that is why you would need to have a divert. It looks like if your portable RO meets quality indicators you would not need a deionizer and there for not need a divert.

San Augustine, for the record, I have no real comment. I am a water guy. Many posters on this site are more qualified to comment on dialysis machine operation and quality of care. My only comment is the goal is for the water and dialysate to be <50 cfu/ml and endotoxin to be <1EU/ml....and these goals will continue to be lowered. If you meet the bacteria/endotoxin limits, then what you are doing should be acceptable. If your dialysis machine has an endotoxin filter, you may be able to get away with longer times between disinfection. On the other hand, getting a bacteria or endotoxin result today that is bad means that the treatments you did a few days ago may have caused health problems.

Personnally, I like disinfecting the dialysis machine at the beginning of the day and at the end of the day after all treatments are done...but, I have never had to do this.

Or, use the NxStage machine for acutes. I don't believe these machines are disinfected. Anyone use the NxStage for acute? How are the economics for this machine in an acute setting?

BTW, thanks Chuck...if only I believed you!

Hi Florian,

At my acute we have several Nxstage machines but they are only used in ICU by the ICU staff
not dialysis nurses and one other department. There are only 2 different dialyzers for the machine and the lines and dialyzers are exspensive. The staff seems to like them but there are limitations. Any disinfections would
be external. The lines like the dialyzer are one use only.
sk8

Larry,

Seriously, I think you're one of the good eggs in the basket! I'm sure your extensive knowledge about water is invaluable to the committee, I know for a fact this it is greatly appreciated here on Renalweb!

I just looked through the list of the RD:52 committee members and I can see at least 8 where there could be a potential for a conflict of interest, 1 that is totally clueless and 1 that lives in the big house at the top of the hill in Eutopia. While the expertise that some of these members bring to the table is needed, the committee needs a much heavier representation by those who actually have to put the "recommendations" to use in the real world.

I was once told by an ex committee member that if an individual represented a manufacturer, they could automatically be included in the committee but, anyone else had to be nominated then accepted, IF there was a vacancy. Is this true?

Chuck

This message has been edited. Last edited by: Chuck W,

quote:

Originally posted by Chuck W:
061####,

AAMI lets themselves off the hook because they say that they don't require anything, only reccommend, its CMMS that makes the regulations, even though CMMS adopts the AAMI "reccommendations" by reference as regulations. They also play symantics with words such as should and shall. When the surveyors see the "recommendation", you best believe they're going to require it.

This AAMI committee is rather dominated by water industry representatives(no offense Larry)....one has to wonder if some of the reasons behind some of their "reccomendations" is to sell more stuff.

Chuck

CMMS does not inspect or regulate hospital acute programs. This falls under JACHO

"Guest",

If the acute program is Medicare certified, it is surveyed by CMS AND JACHO. If it is not Medicare certified you're correct it is only under JACHO. Guess what guidelines JACHO follows? (hint: it starts with a "C").

Here in Maryland, a Medicare certified acute program gets surveyed by the Office of Health Care Quality once every 3 years (for CMS), Maryland Kidney Commisssion every year, and JACHO as part of the hospital survey.

Chuck

I wish none of them came to inspect. Usually, STATE of Texas, does't show up for at aleast 5 years at a time. Pathetic dialysis clinics have so many complaints against them and are doing things so wrong that the state has to babysit them!!