June 28, 2022 admin
Infection control measures in a hemodialysis unit:
Hemodialysis (HD) patients are susceptible to a variety of infections, including bloodstream infections, localised vascular access infections, blood-borne infections like hepatitis B, C, and/or HIV viruses, as well as airborne diseases like tuberculosis. Contaminated water, instrument, and surrounding surfaces in the treatment area are potential sources of infections, as are infected individuals who endanger the health of nearby dialysis patients. HD patients are more likely to develop health-care associated infections (HAIs) due to immunocompromised status, frequent and prolonged blood exposure during HD treatments through the extracorporeal circuit and vascular access, close quarters with other patients during treatment in the HD facility, and frequent contact with healthcare workers who frequently move between patients and between machines. Following cardiovascular disease, infection is the most frequent reason for hospitalisation and mortality in hemodialysis patients. Due to frequent and prolonged contact with numerous potential pollutants in the dialysis environment, HD patients, as well as dialysis personnel, are susceptible to developing health-care-associated infections (HAIs).
One or more of the following causes will ultimately lead to a lapse in recommended practice implementation. The following factors may compromise patient safety: (a) inadequate staffing with a low nurse-to-patient ratio; (b) frequent nursing staff turnover; (c) lack of training or competency among HD staff; (d) insufficient or absent patient/family education; (e) insufficient provision of necessary supplies and equipment; (f) substandard HD unit layout (congested and insufficient segregation/isolation); and (g) the urgency associated with dialysis complications (sometimes life-threatening situations)
Negative versus positive pressure rooms:
An isolation facility aims to regulate the airflow in the room such that the amount of airborne infectious particles is decreased to a level that makes it extremely improbable that other patients will become infected while they are there. In medical settings, efficient positive and negative pressure rooms are a crucial component of the infection control system. In medical settings, these rooms are also known as Protective Environments (positive pressure rooms) and Airborne Infection Isolation Rooms (AIIR) (negative pressure rooms). They keep sterile or constrained environments in place and prevent the spread of infectious pollutants. In positive pressure rooms, the treated region is kept at a higher pressure than the airflow. This indicates that air can leave the space but not enter. Any airborne particle from the room will be filtered out in this way. A negative pressure chamber, on the other hand, uses lower air pressure to let outside air enter the isolated environment by preventing internal air from exiting the room. This captures and maintains potentially dangerous particles in the room. In medical facilities, negative pressure rooms separate patients with infectious diseases (AIIR) and shield others outside the room from exposure. Both positive and negative pressure rooms need the following extra elements to function properly: Utilizing specialist construction and temperature control equipment is necessary when creating positive and negative pressure rooms. To maintain the intended environment, 12 air-flow changes per hour are required as a minimum; however, more air-flow changes may be required depending on the size and use of the room.
Significance of negative pressure rooms:
Infection control measures frequently use negative pressure rooms (also known as airborne infection isolation rooms). Negative Pressure Isolation Rooms are for patients who require airborne droplet nuclei isolation. This includes pathogens such as measles, varicella-zoster (chicken pox), legionella, and tuberculosis. To lower the chance of the infection spreading to others through airborne contact, patients are placed in Negative Pressure rooms. Airborne infection isolation rooms and infectious isolation facilities are other names for negative pressure rooms. A pressure gauge and alarm system should be installed in negatively pressured rooms to warn when saturation is not adequate. The building management system should be connected to display monitors with audible alarms. All these specifications ensure the safety of patients inside the negative pressure room as well as the other patients. The patients infected with communicable diseases and also undergoing dialysis are isolated in the negative pressure rooms. Special precautions are taken while treating the patients in these rooms. The negative pressure rooms in a dialysis centre are equipped with all mandatory instruments that might be required in case of an emergency.
• Garrick, R., Kliger, A., and Stefanchik, B. (2012). Patient and Facility Safety in Hemodialysis: Opportunities and Strategies to Develop a Culture of Safety. Clinical Journal of the American Society of Nephrology : CJASN, 7(4), 680–688. https://doi.org/10.2215/CJN.06530711
• Karkar, A., Bouhaha, B. M., and Dammang, M. L. (2014). Infection control in hemodialysis units: A quick access to essential elements. Saudi Journal of Kidney Diseases and Transplantation, 25(3), 496. https://doi.org/10.4103/1319-2442.132150
• Millson, T. (2022). Infection Prevention and Control Are Crucial in Dialysis Settings. Infection Control Today, 26(3). https://www.infectioncontroltoday.com/view/infection-prevention-control-crucial-dialysis-settings
• Negative and Positive Pressure Rooms 101 | Hospital Infection Control. (2019, April 29). Air Innovations. https://airinnovations.com/blog/negative-positive-pressure-rooms-hospital-infection-control/