A Closer Look into Conditions for Coverage

Isolation Rooms and Hepatitis B

Isolation rooms have been established as a way to separate infected patients from others in order to stem the spread of disease, but there was concern over the need of isolation rooms to treat patients with hepatitis B. The CDC recommends dialysis clinics should have this room with separate machines, equipment, instruments and supplies. However, for clinics in which a separate room isn’t possible, hepatitis B patients should be separated in “an area removed from the mainstream of activity and should undergo dialysis on dedicated machines.”

In addition, the CDC recommends that staffers should not care for hepatitis B and non-hepatitis B patients at the same time.

The new conditions for coverage are taking into consideration that some clinics may need extra time to create an isolation room. Clinics without isolation rooms could see extra costs as a result—such as architectural design, contractor bids, building permits, etc. Therefore, clinics won’t have to be compliant with this condition until February 2009.

Some commenters argued that not every clinic should be required to have isolation because of the low incidence of hepatitis B in dialysis patients. The 2004 reported rate of viral hepatitis B cases was 2.¹ per 100,000, according to CDC data. CMS took this into consideration and said new clinics can request a waiver as long as there is an isolation room in the geographic area that can serve the needs of the local patients.

Hand Hygiene and Catheters

“We would expect that dialysis facilities demonstrate adherence to professional standards of practice for infection control, which includes adherence to hand hygiene guidelines,” CMS wrote in the final rule.

However, there is no clarity as to what guidelines clinics are to follow. During the comment period, there was debate as to whether there was consensus among existing guidelines, most notably from the Healthcare Infection Control Practices and Advisory Committee. CMS didn’t include an established hand hygiene guideline, though. Instead it pointed to its base infection control condition as a suitable answer.

CMS also pointed to the fact that catheter use in dialysis clinics is a common factor in infections among patients. The conditions adopted the guideline already established in the CDC’s “Guidelines for the Prevention of Intravascular Catheter-Related Infections.” (see sidebar) The report described the necessary education, training, surveillance, hand hygiene, aseptic technique and care necessary for catheters. “We expect that incorporation of these guidelines will increase staff awareness of the protections needed for hemodialysis patients with catheters and lead to reduced catheter infections.”