If you or a loved one must visit a dialysis center to receive hemodialysis (a method that removes waste from the blood when the kidneys do not work properly), there are some important things you need to know to prevent infections.

Why is infection prevention important for hemodialysis patients?

  • Infections (including those affecting the bloodstream) are the second leading cause of death among hemodialysis patients.
  • Infections acquired in dialysis units can kill, disable, hospitalize, and/or prolong illness in patients while disrupting lives and increasing the cost of treatment.
  • Dialysis-related infections can occur in many body locations including the bloodstream, bones, lungs, and skin.
  • There are many reasons why patients receiving dialysis have a high risk of infections, including the close distance of patients to each other, the fast patient turn-over between dialysis sessions, and poor health of the person receiving dialysis.
  • The immune system of patients with chronic kidney disease often does not work well, which impairs their ability to fight infection.
  • Some of the medicines may also affect the immune system, which can increase the risk of getting an infection.
  • Frequent admissions to a hospital may also expose patients to infections such as central line-associated bloodstream infections (CLABSI), methicillin-resistant Staphylococcus aureus (MRSA), and catheter-associated urinary tract infections (CAUTI).

What patients can do:

  • Clean your fistula site with soap and water before every dialysis treatment.
  • Clean your hands with  with soap and water or waterless alcohol-based sanitizer before you start your dialysis session and after you leave.
  • If you have a catheter, wear a mask while the nurse is hooking you up to the dialysis machine to prevent germs from your mouth from falling or spraying onto the catheter.
  • If you don’t have a permanent fistula, but will need dialysis for your lifetime, discuss the early placement of a fistula with your doctor, before the need for dialysis.
  • Get the flu vaccine every year.
  • Get the hepatitis B vaccine.
  • If you will receive intravenous fluids, request that they do not use the bag for other patients or set up the intravenous tubing until they are ready to administer fluid to you.
  • Notify a nurse or doctor if the area around the central line is painful or inflamed, secreting (pus), or if the bandage becomes wet or unclean.
  • Seek medical attention immediately if you develop symptoms such as fever, uncommon fatigue, loss of appetite, nausea, vomiting, and/or changes in mental activity. Sometimes patients on dialysis do not develop a fever when they have an infection, so all symptoms are important.

What patients can ask:

  • Ask for a hepatitis C blood test before starting dialysis treatment, and then on a routine basis.
  • Before receiving an injection, ask if the needle and syringe have been newly opened for you since syringes and needles must be used one time only.
  • Ask doctors and nurses to explain why a central line is required, how long you will need to have it in, and if you can use a fistula or graft for dialysis treatment.
  • Ask if the dialysis staff put a new external (transducer) filter on the dialysis machine for every patient and replace the filter when it is soaked with blood. This prevents blood from contaminating the inside of the dialysis machine and prevents patient exposure to contaminants.
  • Ask if the water used for dialysis is routinely tested for bacteria and if there is a policy in case levels are higher than acceptable.
  • Ask if your dialysis caregiver has received the flu vaccine this year.

What patients should observe:

  • Check to see if dialysis staff have cleaned their hands before and after they touch you or your dialysis machine.
  • Make sure your nurse wears a mask during the initiation and discontinuation of the treatment with a catheter.
  • Observe if the dialysis staff cleans the skin of your fistula well with an antiseptic before hooking you up to the dialysis machine.
  • Observe if the chair, table, and machine are cleaned between each patient use.

What family members or other visitors can do:

  • Wash hands or use an alcohol-based hand sanitizer before and after touching you.
  • Wear gloves and a clean cover gown to prevent contamination of clothing.
  • Keep wounds covered with a bandage.
  • Avoid sharing personal items and clothing.

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