Please help! Major discussion fight in our unit about what to do in between patients. Is there a standard that covers this. Should we rinse machines? Should we disinfect the machines? Can we just wipe down the machines and go?
PLEASE HELP!!!!!!!!!!!!!!!!!!!

The only thing we do in my unit is test the machine, or if the first patient is hep c we'll bleach.

What does your unit policy say? We clean the exterior of the machine only before next patient goes on and perform both press. and alarm tests.

We found we actually have no policy for this, that is why I would be asking. We have people that state we should do what you all have recommended here and others who state you must disinfect between patients due to the potential for cross contamination.

Most dialysis machines are single-pass, the water does not recirculate in the machine. Generally, the machines do not require disinfection between patients unless the patient has a disease that requires disinfection after treatment, like Hep C. In our clinic, they wipe down the machine and chair, rinse the machine, and start up with correct concentrates for the next patient, but usually do not disinfect. When we ran Baxter machines, that was it. Now that we have Fresenius, they also run the tests between pts. And, of course, they are supposed to check conductivity and temp before each treatment.

That was key what you stated BMT. You rinse between patients. Why if it is single pass?

Thak you

Tonya, the operator's manual for your equipment would be the best source to find the information that you are looking for. Any surveyor that would review your policies would compare to MFR and AAMI recommendation.

Tonya,
my first question would be what is the benefit of rinsing between patients, if you are using concentrate jugs do you rinse jugs or system between shifts? There really is no logical reason to rinse between shifts other than it's our policy and we've always done this. As stated on an earlier post these systems are single pass, and more importantly the blood and dialysate do not mix. Under certain circumstances (hep c or blood leaks) I can understand disinfection between patients, but as a normal routine I don't see any benefit to rinsing between shifts (CDC guidelines you must disinfect exterior of equipment between patients). I know many facilities start the morning with a rinse but that is to stabilize temperature and make sure pumps do not get airlocked. In between shifts it only rinses out the concentrate, drops conductivity to 0, then you have to bring machine back up to conductivity, test, etc. seems like a large waste of time with no benefit.

I agree with you all. I have been doing this for a long time and have never rinsed or disinfected inbetween patients unless needed. I did not want to persuade anyones answers by already stating my own thoughts. Our manager went to some conference and everything they pushed was safety and she is over thinking everything now.

Do a descale, bleach then disinfect the loop, then the RO. Take culturess, do a water analysis then a staff inservice on oral hygene.

According to Fresenius rinsing in between patients is only needed if you are changing the chemical make up of the next patient,(using a different bath). I work for the dark side and that was is done. Wipe down machine, chair and test machine before new patient. Yet it all depends on your local policy. If none is around I would always default to the machine manufacturer's instructions. These instructions are in your operators book.

It has been our policy to either continue the dialysate flow when there is another patient following directly, rinse between patients if there is a prolonged period of disuse (mostly to save the cost of acid and bicarb), but ultimately to not turn off the machine until after a disinfection, the thought being, bugs generally don't float upstream which is the beauty of a single pass system, however, all bets are off it the machine is turned off, and the bugs get the run of the machine. As an aside, we do disinfect between ALL off unit runs (ICU, CCU, ER, etc). Mostly for the same reason, the potential for bugs floating upstream is increased during transport back to the renal unit. Hope this helps