The opportunity for the human factor to spontaneously respond to an alarm or touch an adjacent machine that is within arms reach can easily be repeated on a constant basis and complicate preventing cross-contamination. It is typically not a willful act to cross-contaminate but it is the end result.
The need to per form proper environmental surface disinfection is greatly increased because of this factor. The challenge is further complicated by the temporal demands that exist in dialysis.
The reality of the temporal demands of a multi-shift schedule is that procedural deviation that conflict with good practice and prioritization, sometimes occurs in order to keep pace with the schedule, maintain pace with fellow caregiver, and to satisfy a waiting patient.
Every dialysis practitioner strives to deliver safe and efficient dialysis but no facility is immune to individuals deviating from established infection control strategies as evident of the most cited Vtags in the recertification surveys.
Compliance with environmental infection control can be complicated by conditions such as the assignment of a typically 1:4 staff-to-patient ratio for the dialysis technician or nurses, the fast turn-around time from patient seating to patient seating, properly performing and allowing the wet-contact time in applying cleaning/disinfection solution, the procedurally intensive process of priming, and put-on/take-off.
In a typical hospital setting, terminal cleaning is performed by staff dedicated to the function of ensuring that the room is properly and completely disinfected from occupancy to occupancy. A typical dialysis unit has no such luxury.
In the absence of such luxury, the nurse or dialysis technician must perform the housekeeping task of surface disinfection (machine, chair, chart, jugs, etc.) in the short gap between patient seating. The time allowed between patient seating can be as short as 15 minutes. In the time allowed, all prior patient supplies and ancillary equipment must be removed or disinfected, properly distributing and preparing treatment supplies for the next treatment and review of orders and previous treatment records has to be accomplished.
The necessity to adjust to the spatial and temporal demands of dialysis has sometimes resulted in the caregiver inventing or utilizing methods that provide convenience and expediency.
Staff must be educated on the proper procedure, and practice audits should be performed to ensure that deviation from protocols is minimized or ideally, eliminated.
Properly cleaning and disinfecting surfaces requires the correct method of wiping and application of the disinfectant.