I Hate Dialysis Message Board
Dialysis Discussion => Dialysis: Centers => Topic started by: bdpoe on May 18, 2007, 04:08:41 PM
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After reading inspection reports from several states at the Association of Dialysis Advocates web site,
and after what I have personally seen as a dialysis patient, Hospitals and Clinics need to constantly strive
to improve sanitation standards.
Do you know that your local fast food joint (which is Gross) is scrutinized and inspected for cleanliness
and sanitation more closely and more often than your local hospital or clinic?
How about your clinic? Have you seen things that could be improved upon?
....bd
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my clinic seems clean. chairs and machines are wiped down with bleach at the end of each session. techs wash their hands frequently. there is someone who walks through frequently looking everywhere checking for dust etc. i realize that probably doesn't happen everywhere
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Not nearly clean enough.
I brought 2 blankets, one under so I didn't have to touch the chair, and one over me. I also wiped the tables, remote and BP cuff with Sani-Cloths before I'd even sit down. Other patients started copying me. :lol; I'm sure the facility director was glad to see me go back to PD.
When I was in the hospital it was worse. The splatter on the walls, hairs in the bathroom. Icccccck!
Can you tell I'm a clean freak? :urcrazy;
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Not nearly clean enough.
I brought 2 blankets, one under so I didn't have to touch the chair, and one over me. I also wiped the tables, remote and BP cuff with Sani-Cloths before I'd even sit down. Other patients started copying me. :lol; I'm sure the facility director was glad to see me go back to PD.
When I was in the hospital it was worse. The splatter on the walls, hairs in the bathroom. Icccccck!
Can you tell I'm a clean freak? :urcrazy;
Dialysis units used to scare me that way. My daughter who was 6 and 7 at the time came over quite often and would spend 1 or 2 hours in the unit before my wife would pick her up. I used to tell her to touch nothing and especially to pick nothing up off the floor. Of course being a little kid she didn't always listen.
Back in those days there weren't many choices for home hemo except for PD. I would have loved to have installed a machine here, bypassing the unit alltogether. Back then it just wasn't in the cards.
It is true that there are bad pathogens lurking in dialysis units. They might even be in the chair next door. It is also true that everyone doesn't subscribe to the same standards of personal hygiene.
Assembly line dialysis...ewww, iccckkk, etc.
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Not nearly clean enough.
I brought 2 blankets, one under so I didn't have to touch the chair, and one over me. I also wiped the tables, remote and BP cuff with Sani-Cloths before I'd even sit down. Other patients started copying me. :lol; I'm sure the facility director was glad to see me go back to PD.
When I was in the hospital it was worse. The splatter on the walls, hairs in the bathroom. Icccccck!
Can you tell I'm a clean freak? :urcrazy;
Dialysis units used to scare me that way. My daughter who was 6 and 7 at the time came over quite often and would spend 1 or 2 hours in the unit before my wife would pick her up. I used to tell her to touch nothing and especially to pick nothing up off the floor. Of course being a little kid she didn't always listen.
Back in those days there weren't many choices for home hemo except for PD. I would have loved to have installed a machine here, bypassing the unit alltogether. Back then it just wasn't in the cards.
It is true that there are bad pathogens lurking in dialysis units. They might even be in the chair next door. It is also true that everyone doesn't subscribe to the same standards of personal hygiene.
Assembly line dialysis...ewww, iccckkk, etc.
Unfortunately home dialysis isnt in the cards for me. I am amazed at the low standards
I hear similar horror stories about nursing homes.
....bd
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One phone call to the Health Dept would fix most of these problems.
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I don't see anything that stands out at my unit. Relatively clean and what I would expect overall for a medical unit. I would not give it a 10 but there is no need for any phone calls. Today I witnessed a tech pick something off of the ground and not change their glove afterward. They did not handle any patients that I saw but I tend to think they were not conscious of it and would have interacted with a patient if that had been the immediate need. I could be wrong.....but I don't think I am.
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One phone call to the Health Dept would fix most of these problems.
Unfortunately it takes a few calls before they send someone out, unless the accusations are really horrid.
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Now who was it who had the opussum in the clinic last year? Somewhere in Australia I think. :sarcasm;
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My former centre wasn't totally gross, but it could have been a lot better. The machines and chairs were wiped down after each treatment, but most of the chairs had old blood stains on them, and the floor wasn't always clean. Most of the techs were good at changing gloves, but one tech got in trouble because she started to take me off without putting on a mask. The training room of my new home centre is pretty clean, and I haven't seen any obvious sanitary problems. Now if only we could fix the squeaky blood pump on the training machine :thumbdown;.
Adam
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I hate cockroaches.
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My husbands clinic is spotless-I am very impressed with how consciously they keep sanitary procedures in place. When we went to Olando to see about the NX-Stage-one of the things that made him say he would wait for Nx-Stage to come closer to us, was the fact that the clinic in Orlando was filthy- the floors were dirty, and the bathrooms were not only dirty, but had bar soap, which just seems icky to me. I was totally shocked, I guess I thought all the clinics would be spotless too.
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The reason I am posting this is to note the bacteria in the soap dispenser. My sure your clinic uses soap in a bag that is discarded when empty. After reading this article, I stopped using the soap dispenser in public restrooms. I carry my own hand sanitizer. :secret;
BETHESDA, MD, 30 May 2001 — A practice designed to reduce medication costs led to a cluster of bacterial infections among patients treated at a Colorado hemodialysis center, say public health scientists.
Despite instructions in the product labeling to discard any unused portion of single-dose Epogen, by Amgen Inc., the hemodialysis center’s staff routinely withdrew and pooled residual epoetin alfa for later use. This practice, which involved repeated puncturing of the stopper on preservative-free vials, led to a rash of Serratia liquefaciens infections among hemodialysis patients. In all, 15 patients showed evidence of infection with S. liquefaciens, a gram-negative bacterium rarely found in humans, over a six-week period in 1999.
The source of the infections was traced by scientists at the Centers for Disease Control and Prevention (CDC) and the Colorado Department of Public Health and Environment, who reported their findings in the May 17 New England Journal of Medicine (NEJM).
The CDC-led investigation focused on 208 hemodialysis sessions involving 48 patients treated on days during which the hemodialysis center’s staff reported bloodstream S. liquefaciens infections. Twelve hemodialysis sessions were associated with bloodstream S. liquefaciens infection, and eight with fever indicating a possible infection. Five patients had a bloodstream infection or fever during two hemodialysis sessions.
Nearly two thirds of the 97 empty epoetin alfa vials kept by the hemodialysis center during the investigation were found to be contaminated with S. liquefaciens. In addition, a bacterial reservoir was discovered in a liquid-soap dispenser that had been repeatedly topped off with new soap instead of discarded or cleaned between fillings. The bacterium was also detected in a bottle of hand lotion located in the center’s medication room.
At CDC’s recommendation, the hemodialysis center ceased pooling preservative-free epoetin alfa and switched to disposable soap containers. These practices ended the S. liquefaciens outbreak.
The Colorado center’s policy of repeatedly puncturing epoetin alfa vials and pooling residual medication, said the report, seemed to be a cost-saving measure suggested to the nursing and technical staff. The investigative team was unable to pinpoint the origin of the suggestion.
The team found, through use of a survey mailed to 103 hemodialysis facilities, that lapses in infection-control procedures are common during preparation of epoetin alfa doses. Of the 71 centers that returned the anonymous survey, 82 percent used the preservative-free, single-dose formulation of epoetin alfa. Seventy-eight percent of these centers reported routinely puncturing the vials more than once to remove additional doses of medication. Sixteen percent of these centers routinely pooled residual epoetin alfa into a common container for later use.
The report estimated that a hemodialysis center serving 150 patients each year could recover up to $180,000 over the annual Medicare payment for epoetin alfa doses if the entire volume in each vial were dispensed. Discarding unused medication, in contrast, could lead to the "waste" of $1.1 million worth of drug each year. These estimates were based on the 1997 Medicare reimbursement rate of $10 per 1,000 units of epoetin alfa.
A 1997 report by the Department of Health and Human Services' Office of Inspector General (OIG) stated that Amgen places an extra 25 percent volume of Epogen in each vial to compensate for material that cannot be withdrawn from the container. According to OIG, which communicated its findings to the Health Care Financing Administration, "there are indications that some free-standing dialysis facilities…use, on average, one half of the overfill which would materially affect each provider's cost."
The OIG report did not address whether facilities using the overfill had purchased multiple-dose vials, which contain a preservative.
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When we were Renal Care we had better supplies. Once Fresenius took over they got rid of some and starting using cheaper supplies. We no longer have throw away sheets for the chairs. They wipe the machine, chair, and tv down after each treatment. Most of the people at my center are elderly and one gentleman has down syndrome. I love him dearly but he has a facination with his nose. So if i sit in his chair after he leaves i usually have some little presents that they have negleted to wipe. I am on third shift 3-7. By the time i get there the floor is a mess. Blood, needle covers, food, etc... the chairs are old blood stained tape over holes and cracks. The tv's usually have a few surprises on them. The worst is the patient bathroom. Although the sign says "Patients only" no one obeys it. Delivery people, ambulance drivers, etc... use it all the time. Allot of the time after dialysis you have to get rid of more than blood but i would'nt sit on those seats if you would pay me! The walls are splattered with unknown fluids. They all wear the throw away lab coats and gloves. Only one wears the welders mask. When i had my catheter once i was sent home with the syringe still attached. Many times i went home without a cap or two. When a inspecter comes they all wear the appropriate gear.
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When a inspecter comes they all wear the appropriate gear.
That is so irritating. They can't even argue they didn't know any better. When it comes to covering their asses they all follow procedure, but to protect the patients...no way. :banghead;
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When Jenna was exploring the option of home dialysis, I asked her Neph about it because we have 4 kids and a busy household. I said "But I am worried about doing needle sticks at home, what about typical household germs?" His response was, "There are a thousand times more germs in the dialysis clinic than in your home." :o
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We just moved to a brand new Dilaysis clinic so everything is pretty new and clean. I do have the disadvantage of being one of the last patients of the day so I have to deal with the disgusting bathroom. It grosses me out just thinking about what's left in there because people are too lazy to flush.
I have the opposite problem most people have on this site...I don't have much of a problem with the staff, it's the rude patients that drive me crazy.
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Holy cow! Did I want to know all of this! :sarcasm; Eventually they are going to kill me off, huh?
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Not nearly clean enough.
I brought 2 blankets, one under so I didn't have to touch the chair, and one over me. I also wiped the tables, remote and BP cuff with Sani-Cloths before I'd even sit down. Other patients started copying me. :lol; I'm sure the facility director was glad to see me go back to PD.
Well I think I will be taking some sort of a sani-cloth with me from now on.
I have noticed that the tables connected to the arms of the chairs are not always very clean. Sometimes I've seen faint blood stains that weren't wiped completely off. And yes, I have touched 'em. Eewwww! ! ! The little tables lay flat and you have to pull 'em up and lot 'em into place. I'm gonna have to wipe 'em down before I touch 'em. Also the tv remotes, I've never seen anyone wipe them down. I had one that was just covered in...well only god knows what! I don't even watch tv anymore. I just hook up my ipod and go to sleep. The nurses are really good with changing their gloves, wearing their smocks and masks and washing their hands. I won't even go near the restrooms. I think for the most part they are clean. I went in once but it was just to check my hair. LOL....I just can't use public restrooms, or friends restrooms, I couldn't even use the bathroom at school. I can only use my own or immediate families.
I'm totally loco when it comes to restrooms. :urcrazy;
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My unit is pretty good. Nurses washing their hands ad nauseum and if they need to go from one patient to another it's instant new gloves.. chairs wiped down after use inc machines, tables etc.. any spillage of anything - specially blood is jumped on and special stuff used to neutralise and clean it up. No real issues at all. I'm sure it's not perfect but it's hardly the worst either.
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When we were Renal Care we had better supplies. Once Fresenius took over they got rid of some and starting using cheaper supplies. We no longer have throw away sheets for the chairs. They wipe the machine, chair, and tv down after each treatment.
I do know that the supplies Fresenius uses are not the highest quality in the world, but there is no reason you should not be able to get drape sheets for your chairs still. All the clinics in my area use them and I couldn't see not using them. Besides they are a non-inventoriable item so they dont effect your PI-17 in any way. Tell who ever orders your supplies to add part number 17-0159-2 for drape sheets to the order.
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From reading the postings on sanitation and cleanliness. many of you mentioned dirty patient bathrooms, stained chairs
and side tables, remotes not being wiped down, amoung other gross things. Some mentioned the cliinic's name and others did not. Many of the same problems exist in Hospital units as well.
Is this dangerous? Most definitely! If these things you've noticed are lacking, what else is going on that you
don't see?
Please all of you let us know how is your clinic when it comes to sanitation and cleanliness.
THANKS
.........bdpoe
Not nearly clean enough.
I brought 2 blankets, one under so I didn't have to touch the chair, and one over me. I also wiped the tables, remote and BP cuff with Sani-Cloths before I'd even sit down. Other patients started copying me. :lol; I'm sure the facility director was glad to see me go back to PD.
Well I think I will be taking some sort of a sani-cloth with me from now on.
I have noticed that the tables connected to the arms of the chairs are not always very clean. Sometimes I've seen faint blood stains that weren't wiped completely off. And yes, I have touched 'em. Eewwww! ! ! The little tables lay flat and you have to pull 'em up and lot 'em into place. I'm gonna have to wipe 'em down before I touch 'em. Also the tv remotes, I've never seen anyone wipe them down. I had one that was just covered in...well only god knows what! I don't even watch tv anymore. I just hook up my ipod and go to sleep. The nurses are really good with changing their gloves, wearing their smocks and masks and washing their hands. I won't even go near the restrooms. I think for the most part they are clean. I went in once but it was just to check my hair. LOL....I just can't use public restrooms, or friends restrooms, I couldn't even use the bathroom at school. I can only use my own or immediate families.
I'm totally loco when it comes to restrooms. :urcrazy;
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Let me rephrase this question. How clean and sanitary is your nurse, facility, hospital or doctor's office and what improvements would you like to see? Please note your city and state if possible.
In Duh Vita is bad gr8ful, a nurse manager I think, said her dad caught MSRA a hospital born illness and I recently
read that something like 1 out of 136 patients are harmed in some way in the hospital. Those aren't very good odds
in my book. Now think about it in your clinic.
Sanitary Clinics, hospitals, restaurants, food and tap water are big issues with me.
"You should've seen just what I saw" Bo Diddly
.......bd <-----Monked Out To The Max
From reading the postings on sanitation and cleanliness. many of you mentioned dirty patient bathrooms, stained chairs
and side tables, remotes not being wiped down, amoung other gross things. Some mentioned the cliinic's name and others did not. Many of the same problems exist in Hospital units as well.
Is this dangerous? Most definitely! If these things you've noticed are lacking, what else is going on that you
don't see?
Please all of you let us know how is your clinic when it comes to sanitation and cleanliness.
THANKS
.........bdpoe
Not nearly clean enough.
I brought 2 blankets, one under so I didn't have to touch the chair, and one over me. I also wiped the tables, remote and BP cuff with Sani-Cloths before I'd even sit down. Other patients started copying me. :lol; I'm sure the facility director was glad to see me go back to PD.
Well I think I will be taking some sort of a sani-cloth with me from now on.
I have noticed that the tables connected to the arms of the chairs are not always very clean. Sometimes I've seen faint blood stains that weren't wiped completely off. And yes, I have touched 'em. Eewwww! ! ! The little tables lay flat and you have to pull 'em up and lot 'em into place. I'm gonna have to wipe 'em down before I touch 'em. Also the tv remotes, I've never seen anyone wipe them down. I had one that was just covered in...well only god knows what! I don't even watch tv anymore. I just hook up my ipod and go to sleep. The nurses are really good with changing their gloves, wearing their smocks and masks and washing their hands. I won't even go near the restrooms. I think for the most part they are clean. I went in once but it was just to check my hair. LOL....I just can't use public restrooms, or friends restrooms, I couldn't even use the bathroom at school. I can only use my own or immediate families.
I'm totally loco when it comes to restrooms. :urcrazy;
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Well, I have yet to be in any medical facility that was cleaner than my home. And I have a very hairy and rambunctious dog.
Walls and furniture need to be washed, just like floors, and it needs to be done well. Ceiling tiles and vents also need to be cleaned and replaced frequently. Sometimes I feel like I am the only one who sees dirt. :urcrazy;
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What is your hospital, clinic or facility doing to increase sanitation and
cleanliness? Chances are not much aside from a little lip service.
With several states, including Florida, faced with dramatic cuts in social services Healthcare is targeted to take a direct hit which has doctors,
clinics and hospitals worried.
In the USA your chances of getting a Hospital-acquired infection (HAI)
are approximately one in 136. But some feel that number is lower
than what it should be as many cases are denied, contested or simply overlooked. Officially the US rate of infection is about half of what it is
in Britain.
At issue are dramatic cuts in Medicare and Medicaid at respectively the
state and federal levels. Then, in Florida, Governor Crist's recent mandate
that all agencies cut spending by 10%. That means less monitoring, less inspecting, less staffing while the chronically ill and medically needy suffer a reduction in services. A prescription for suffering.
Medical Bills are the #1 cause of bankruptcy and homelessness here in
the USA. Aside from lip service and phony promises, our candidates,
legislators and elected officials seemingly fail to realize the seriousness
of our health care crisis and make the cure a top priority.
...bdpoe
Dirty hospitals must clean up, says Brown
Jo Revill, Whitehall editor
Sunday July 1, 2007
The Observer
A drive to slash the rates of MRSA and other hospital infections is being masterminded by Gordon Brown, who is convinced that the public's perception of the NHS has been swayed by concerns over cleanliness on the wards.
Brown has told close colleagues that they will never win 'hearts and minds' over the health service reforms until they can demonstrate that the wards really are cleaner, and that they are cutting the numbers of patients being infected.
The Prime Minister and his aides have become alarmed that one in four hospitals is still not meeting the hygiene targets imposed in November 2004 by the then Health Secretary John Reid. Hospital-acquired infections (HAI) now affect some 300,000 people a year, and despite better control measures appear to be epidemic in some areas. The government is unlikely to meet the target it has set itself, of halving the numbers diagnosed with MRSA by next April.
Brown chose to highlight the issue of hospital cleanliness yesterday, on his first visit to a hospital - Kingston, in south-west London - as Prime Minister. A team of experts is being set up within the Department of Health to look at new measures to deal with the problem. The new health minister, the surgeon Professor Ara Darzi, will be asked to devise a new strategy to combat the infections.
Since MRSA first hit British hospitals 10 years ago, it has spread across the country, as an increasing number of people became resistant to antibiotics, coupled with poor cleaning on the wards and the fast turnover of patients.
In recent weeks, Brown has been touring the country listening to Labour supporters and the public. One aide told The Observer that the Prime Minister had been dismayed by the numbers who put MRSA top of their priorities for the NHS. 'We've been thinking that tackling the waiting lists is the number one issue, along with better access to the GP, but we know that dirty hospitals are in the public mind,' the aide said.
The new Health Secretary, Alan Johnson, visited Kingston hospital with Brown yesterday, where they learnt how the hospital had managed to reduce its MRSA rate by 47 per cent.
The hospital imposed a stringent system of hand hygiene compliance and general cleanliness. Posters have been put up urging visitors and staff to wash their hands, and a team goes around the hospital every week and observes staff to give them a hygiene compliance score.
Other hospitals are also tackling the superbug. In the final quarter of last year, 1,542 patients had MRSA infecting their bloodstream, seven per cent fewer than in the previous quarter.
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Normally, the Streetsboro, OH treatment center is clean. They wipe down the chairs and machines, bathrooms are clean, etc. However, there is a practice I disagree with which I made the decision to change clinics. On Monday, Sept 2. 2007 I wasn't feeling well. I was able to sleep in the chair after my ca nillation. When a patient has to use the restroom, the practice in the Streetsboro, OH clinic is to have the patient defecate in a bag with a toilet rim over it. The patient is surrounded by curtains. On Monday, after the patient filled the bag, the staff just left it there. To make matters worse, they were just standing on the other side of the room gossiping about trivial matters such as birthdays, TV shows, etc. I wanted to vomit. I couldn't take the stench anymore, and I complained about it. I also demanded to get the hell out of here. Once the staff realized I was complaining about the bag, they finally got around to disposing it. After I got home, my wife called and complained - but got nowhere. We also talked with the clinic manager and I explained to her how I know more about what's happening in the clinic than she does. I told her about the declining quality of care by her staff, and my opinion how they care more about corporate policy than patients. I was told policy was in place for "patient safety." I gave several examples of various dialysis centers I've been to over the years that contradicted what she was telling me. For example, letting the patient off the machine (with needles in), and letting them back on after using the bathroom. Of course, being a good corporate lackey, she defended her staff and said "I'm sorry you feel this way....I have meetings with my staff so I know what's going on here." My wife asked for a copy of the policies we were questioning and we were told we could get a copy on Friday (Tomorrow). So, because of a cumulative series of things, I have decided to transfer to another clinic. I've also called the Portage County, OH board of health, but they told me they have no jurisdiction over dialysis centers. My wife wants me to "press the issue." However, if no patients complain, nothing else will be done. I'm already labeled a whiner in my clinic, but I don't care - if something is wrong I'm going to speak up. I wish other patients would do the same.
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Sorry that had to happen to you. There should be a Greivance Poilcy posted in the lobby of your dialysis clinic. It tells you whom to notify with complaints you may have - usually it is the clinic manager first (you've done that), then their boss (Area Mgr) then their boss (Regional Vice President) and then your Network office. If it is not there, you should have received a copy on admission from your MSW. If you get no satisfaction you can contact the state agency that certifies your dialysis clinic, CMS, or if your state has a Kidney Commision, as we do in MD, file a complaint with them. There should be a copy of the facility's license in the lobby as well; you can see what agency to contact on that. That is really terrible. We usually do as you first cited; take the patient off ( needles in ) take them to the rest room, let them do their business, and then reconnect.
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When a patient has to use the restroom, the practice in the Streetsboro, OH clinic is to have the patient defecate in a bag with a toilet rim over it. The patient is surrounded by curtains.
Wow they actually had someone poop while on the floor. That is completely gross and unacceptable in my opinion. At my clinic we do have the privacy curtains and urinals for the men to use if they need to pee while hooked up, but even that is their choice to do while still hooked up. If one of the female patients needs to use the restroom they will be unhooked brought out and back again when done. Since you didn't list the company name I can only guess what company it may be but I know Fresenius has no such restroom policy.
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At my old centre, if a patient had to use the bathroom, they were usually taken off, and put back on after they were done. That wasn't the case all the time however. If a patient was in a wheelchair and couldn't get to the bathroom without assistance (being able to move themselves in the wheelchair), out came the bed pan and the privacy curtains. There was one lady in particular who had some GI problems and was always having to go. She was in a wheelchair, and could only be taken somewhere with assistance. She usually had the curtains up for most of her run. She was a nice lady (although sometimes she could be unpleasant if she was in a bad mood), but I was always glad I never had to sit next to her. I never had to be taken off to use the bathroom when I was there, but there have been a few times since I started NxStage where I've had to take myself off temporarily to visit the porcelain thrown.
Adam
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When a patient has to use the restroom, the practice in the Streetsboro, OH clinic is to have the patient defecate in a bag with a toilet rim over it. The patient is surrounded by curtains.
Wow they actually had someone poop while on the floor. That is completely gross and unacceptable in my opinion. At my clinic we do have the privacy curtains and urinals for the men to use if they need to pee while hooked up, but even that is their choice to do while still hooked up. If one of the female patients needs to use the restroom they will be unhooked brought out and back again when done. Since you didn't list the company name I can only guess what company it may be but I know Fresenius has no such restroom policy.
Actually, it is Fresenius. I HOPE they find this board, I talk about it frequently. I even put my picture to show them it's me who told what happened. I've been to other clinics where they allow people off the machine to use the bathroom.
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Off topic, cabarle, nice pic. ;)
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Hi Cabarle, here is a link that you can print out a flyer so you can show them and they can come and check us out for themselves :2thumbsup; http://www.ihatedialysis.com/images/dialysisflyer01.pdf Thank you for letting others know about us :clap;
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Actually, it is Fresenius. I HOPE they find this board, I talk about it frequently. I even put my picture to show them it's me who told what happened. I've been to other clinics where they allow people off the machine to use the bathroom.
Sounds to me like they are just lazy and don't want to have to rinse people back and then re-hook them when they return. Especially if you run 3rd shift because that adds more time to the treatment length and more time they would have to wait before going home.
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Here is some information from AAKP on what you can do about filing complaints against a dialysis center.
http://www.aakp.org/aakp-library/Concern-With-Dialysis-Facility/
What Should I Do If I Have a Concern With My Dialysis Facility?
By Mark Meier, MSW, LISCW
As a dialysis patient, to a certain degree, you must rely on others for your well-being. You arrive to each dialysis treatment anticipating that the nurses, dialysis technicians, physicians and other clinic staff will appropriately initiate your treatment, monitor you closely during your treatment and safely discontinue your treatment at the end of your prescribed run time. You also rely on your healthcare team to provide you with current treatment and medication options, educate you about your dietary needs and provide you with resource information that pertains to your needs outside of the dialysis clinic. Along with your reliance on the healthcare professional, you also have the right to have expectations about the level of care you receive in your clinic. You should be able to expect that the care you are receiving is performed safely, within the policies and procedures established by the clinic, directed by your physician, and occurring within generally accepted medical practice. Relying on healthcare professionals and having expectations about the level of care you receive are normal aspects of the patient/provider relationship and on their own or in combination should not be problematic.
However, challenges might arise for you as a patient when the expectations you have for your care are not being met by the very same professionals you rely on for your safety and well-being. It can be a daunting and intimidating task to question or complain to, or about, the professional who is responsible for your care in so many ways. This article will help you to identify positive, proactive steps to take when identifying, reporting, and following up on a complaint about your dialysis clinic or care. You will also be provided with outside resources to utilize if you are unable to obtain a resolution within your clinic system.
Identifying a Complaint
What type of situation merits reporting as a complaint? The answer to this question is going to be different for each patient and there is not a specific answer about what to register as a complaint. Generally, complaints fall into three categories: (1) Treatment-related, (2) Staff-related and (3) Dialysis-clinic related. Treatment-related complaints often reflect the perception that some aspect of the initiation, maintenance, or discontinuation of the dialysis run has been performed incorrectly. Staff-related complaints frequently relate to patient and staff conflicts or disagreements. Dialysis-clinic related complaints focus primarily on the operation and cleanliness of the dialysis center. All three categories have merit and none should be considered more important than the other should. What is important is that once you have identified a complaint that you take the next step and report the complaint.
Reporting a Complaint
The very nature of the word “complaint” conjures up a negative image and the clichés about “complainers” are numerous. Furthermore, it can be intimidating and stressful to raise concerns about the doctors, nurses, technicians and other healthcare providers who care for you on a daily basis. However, when you have identified an area of concern, it is important to make those aware who have the capability and authority to improve the issue. When reporting your complaint, it is important to understand the complaint or grievance process your clinic has established. The End Stage Renal Disease (ESRD) Federal Regulations, maintained by the Centers for Medicare and Medicaid Services (CMS), require that each dialysis facility have a process in place to address patient complaints. The regulations further require that each dialysis clinic provide patients with specific information that explicitly informs them of the process for filing a complaint and that the patient (or patient representative) is able to file a complaint “…without restraint or interference, and without fear of discrimination or reprisal” (Conditions of Coverage of Suppliers of End Stage Renal Disease, CFR42 405.2138 Patients’ rights and responsibilities). Despite these printed assurances in the Federal Regulations, you still might not feel comfortable reporting a complaint in your clinic. You always maintain the right to forgo the complaint policy implemented by your clinic and report the concern directly to your ESRD Network, which will be discussed later in this article.
If you have identified a concern, which might be a single incident or a pattern of incidences that you wish to report as a complaint, it is important to be thorough and specific with all components of your complaint. For example, a general complaint about a dirty clinic is more difficult to address than a complaint about unwashed dialysis chairs or used medical supplies being disposed of inappropriately. If you have a concern with a particular staff person, it is important to report your concern in an objective, concrete manner, which describes precise behaviors or actions. The use of offensive language, name-calling or insults will likely exacerbate your concern rather than improve it. Further, it is important to know the person’s name and position when reporting your concern. Specific dates and even the time of an incident will allow those addressing the complaint to narrow down and deal with the concern.
The method in which you report the complaint is also important. As noted above, the dialysis clinic is required to have a procedure in place for reporting complaints, and they will likely request that you follow this procedure. The procedure will probably contain provisions to put your complaint in writing and to follow a chain of command in filing the report. For example, you might be asked to speak with the social worker first and then speak with the charge nurse, clinic manager, and so forth, working your way up the levels of management in the clinic. This procedure can be useful and helpful to you as a patient for many reasons. First, it provides you the opportunity to put your complaint in writing as an official notice of your concern. Second, it gives both you and the clinic a written description of the specifics of the complaint to refer back to in the process of responding to the complaint. Third, it gives the staff that works in the clinic on a daily basis an opportunity to respond to and resolve the complaint. This method of reporting also allows a measure of confidentiality for the person reporting the complaint.
Reporting a complaint in this written manner allows the clinic staff person who is responsible for dealing with complaints an opportunity to approach the person(s) whom the complaint is about away from the treatment floor and in private. In responding to a complaint, the primary objectives of the clinic management should be to establish the validity of the complaint, resolve the complaint in a reasonable manner and period of time and to educate and provide further training to the staff so the concern is solved for both the short-term and the long-term. In fairness to the staff person about whom the complaint is brought against, they should generally be afforded the opportunity to be made aware of the problem, educated and trained further as necessary and given an opportunity to correct the issue.
Following Up On a Complaint
In order for a complaint policy to be effective and complete, there must be a mechanism in place for follow up. Most clinic policies state the time period in which the facility will act once receiving a complaint and what action will be taken in response to the complaint. You should receive a response to your complaint in writing with some detail of the plan of correction and future plans to prevent the problem from reoccurring. The response you receive should also contain a description of the process or the resources you can utilize to appeal the decision. If you are satisfied with the resolution, providing constructive feedback and encouragement to those who have helped to solve the issue is helpful to maintain the changes that have been implemented.
Alternative Complaint Resources
If you have identified an area of concern and you do not feel comfortable reporting a complaint to your physician or using the grievance process put forth by your clinic, you always have the option of reporting the complaint to outside agencies. The two primary agencies are the ESRD Networks and your State Survey Agency. Both are capable of receiving and acting on your complaint either alone or with the other agency.
The ESRD Networks, of which there are 18 throughout the country, are contracted by CMS to receive and act upon patient complaints. Your clinic should have your Network’s number posted or you can ask a staff person to provide you with the telephone number. You can also access the Forum of ESRD Networks on the Internet at www.esrdnetworks.org. This site contains a detailed map of the areas covered by each ESRD Network, as well as a link to the Web site of each individual Network.
The other alternative is to contact your State Survey Agency directly. State Survey Agencies are responsible for the licensing and certification of outpatient dialysis clinics and handle individual patient complaints. You can access a directory containing the contact information for your State Agency on the CMS Web site at www.cms.hhs.gov.
Conclusion
Receiving and providing quality care in an environment free of problems is the goal sought by most patients and healthcare professionals. However, like the rest of the world, problems arise which are uncomfortable to face and sometimes difficult to solve. When a problem does come up, you as a patient have the right to report this complaint, expect action to improve the situation and be informed of a plan to prevent the problem from returning. You should be able to report this complaint without the fear of reprisal or retaliation from the staff that cares for you. Along with these rights, you also have responsibilities in the clinic in relation to complaints. If you identify a problem, it is your responsibility to report the issue in a manner that the complaint can be acted upon and the problem area resolved. You are also responsible for understanding your clinic’s complaint process or to know whom else you might contact to solve the issue.
The outpatient dialysis clinic is a fast-paced, dynamic and highly sophisticated environment. It is inevitable that certain problems or challenges will surface. However, if complaints are reported and received in a professional manner and you and your clinic staff share the same goal of resolving the complaint to improve the operations of your clinic, the identified problem can be solved in a positive manner to benefit both patients and staff.
Mark Meier, MSW, LICSW has been the Consumer Services Coordinator at Renal Network 11 since 2001. He recently served as the study coordinator for the 2002 National Involuntary Patient Discharge Survey involving 12 ESRD Networks. Mr. Meier is active with the AAKP and was recently elected to the AAKP Board of Directors.
This article originally appeared in the November 2003 issue of aakpRENALIFE Vol. 19, No. 3.
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One phone call to the Health Dept would fix most of these problems.
Unfortunately it takes a few calls before they send someone out, unless the accusations are really horrid.
Skip the Health Department--contact OSHA, The Occupational Safety and Health Administration. It may be for "employees," but they are STRICT when it comes to medical facility cleanliness, laws and regulations. I had to deal with them when I worked for a vet. They don't mess around--and they LOVE to fine facilities!
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Hi guys,
It sure is nice to come here and talk with people who actually understand what I am experiencing. To make a long story short, my biggest advocate (my wife) chewed a new anal cavity into both the head nurse and the clinic manager. I decided that no matter who I complain too, nothing is going to change - mostly because the rest of the patients choose to remain silent. So, I start treatment at another facility next Wed. I will post the IHD poster on my last treatment on Monday.
Hawkeye: You hit the nail on the head. I can't say the staff at Streetsboro is "Lazy", but rushed. I understand they're pressed for time between patients. Although, I've always said the center has chosen profits before people, hence my decision to leave. Simple things like temperature (adjusted to the staff's comfort, not the patients), applying the tourniquet on too tight, generally loud conversations while everyone is trying to sleep, etc, etc. Another thing that concerned me was I've heard from the staff how they absolutely hate their jobs. They complain about low wages, long hours, - you get the idea. I suspect everyone here has heard the same complaints. To make matters a tad worse, I suffer from major depression - and even the slightest comments like "Grow Up", "Get off your soapbox", make me just want to end it all. I've since sought counseling and medication and no longer feel that way. Instead, I just tell them the truth - and they don't like it.
BigSky - Yes. all of the complaint procedures are nice if they work. I've made several calls and sent several e-mails to various authorities. However, the reality is because I chose to leave Streetsboro, OH, my complaint will be buried by the clinic and ignored by any authority. I also explained if I decided to stay, the staff can do "little things" to exact their revenge. Although I had assurances from the Clinic Manager they were above reproach to that, I choose not to gamble on her word and leave while I'm healthy enough.
Angela515: I know it's off topic, but for the record: I'm retired Navy and I volunteer with a youth program called the U.S. Naval Sea Cadet Corps in Cleveland, OH. My daughter is in the program. At this stage in life, it's the closest I can come to my beloved U.S. Navy.
:rant;
One phone call to the Health Dept would fix most of these problems.
Unfortunately it takes a few calls before they send someone out, unless the accusations are really horrid.
Skip the Health Department--contact OSHA, The Occupational Safety and Health Administration. It may be for "employees," but they are STRICT when it comes to medical facility cleanliness, laws and regulations. I had to deal with them when I worked for a vet. They don't mess around--and they LOVE to fine facilities!
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... generally loud conversations while everyone is trying to sleep, etc, etc. Another thing that concerned me was I've heard from the staff how they absolutely hate their jobs. They complain about low wages, long hours ...
This stuff has happened at my center over the years, but thank God people either get fired or tired and move on.
Never let the bastards get you down!
:beer1;
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I have written several letters to the head of the dialysis unit I was at when conditions were not good. They have to deal with a complaint that is in writing.
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It sure is nice to come here and talk with people who actually understand what I am experiencing.
:cuddle; Support is only the keyboard away. Don't stay away so long next time! ;)
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It sure is nice to come here and talk with people who actually understand what I am experiencing.
:cuddle; Support is only the keyboard away. Don't stay away so long next time! ;)
Wattle is so right, :clap; then again, so is Cabarle ;) ;) :2thumbsup;
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Another question those on in-center hemodialysis need to ask is how often are the dialysis machines bleached. After each treatment or just at the end of the day?
And if you're on the Fresenius 2008K dialysis machine, how often do they heat sterilize it? At the end of the day or just once a week?
8)
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Another question those on in-center hemodialysis need to ask is how often are the dialysis machines bleached. After each treatment or just at the end of the day?
And if you're on the Fresenius 2008K dialysis machine, how often do they heat sterilize it? At the end of the day or just once a week?
8)
Our unit does it at the end of the day.
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Another question those on in-center hemodialysis need to ask is how often are the dialysis machines bleached. After each treatment or just at the end of the day?
And if you're on the Fresenius 2008K dialysis machine, how often do they heat sterilize it? At the end of the day or just once a week?
8)
I am curious to know what is recommended Zach. At the end of each treatment or the end of the day?
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Another question those on in-center hemodialysis need to ask is how often are the dialysis machines bleached. After each treatment or just at the end of the day?
And if you're on the Fresenius 2008K dialysis machine, how often do they heat sterilize it? At the end of the day or just once a week?
8)
I am curious to know what is recommended Zach. At the end of each treatment or the end of the day?
The Fresenius 2008K and H machines must be acid rinsed (Vinegar rinse) and heat disinfected at the end of each treatment day with the exception of once a week they must be bleach disinfected instead of heat disinfected.
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The clinic floor is really good about being clean and making sure all cleaning procedures are adhered to.
But because I'm the last patient of the day, I have to deal with a bathroom that never gets cleaned until the end of the day. People crap on the side of the toilet and the floor, it's really disgusting and considering I'm nauseous when I come in to begin with, it is not a great way to begin treatment.
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Another question those on in-center hemodialysis need to ask is how often are the dialysis machines bleached. After each treatment or just at the end of the day?
And if you're on the Fresenius 2008K dialysis machine, how often do they heat sterilize it? At the end of the day or just once a week?
8)
I am curious to know what is recommended Zach. At the end of each treatment or the end of the day?
The Fresenius 2008K and H machines must be acid rinsed (Vinegar rinse) and heat disinfected at the end of each treatment day with the exception of once a week they must be bleach disinfected instead of heat disinfected.
Just to amend this a bit they should be washing the outside of the machine with a 1:100 bleach solution after every treatment, and if your machines have drain boards on the sides of them they should also be dumping that same solution down them between each treatment as well.
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So, I'm getting dialysis in a hospital in Florida and even the nurse agrees with
me that the unit is very dirty or unsanitary.
Now that Florida is cutting most agency's budgets by another 10% and hospitals
brace for Medicaid cuts things look rather grim.
So dialysis facilities in Florida will be inspected even less.
Doctors and hospitals are already dumping medicare and medicaid patients.
Seems Florida's solution is to force the disabled poor to move out of state.
Too many can't afford to move. they are trapped.
Well, in between my fighting with various state agencies and health care provider,
and bouts of depression, I'm still here........for now.
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Too many hospitals and clinics here in Florida need to pay attention to cleanliness, sanitation, personal hygene and
infection control. We are 3 to 4 years behind the UK on addressing MRSA and other hospital/facility borne infections.
Unfortunately this state seems unconcerned....................bd
Staph Fatalities May Exceed AIDS Deaths
By LINDSEY TANNER,
AP
Posted: 2007-10-17 12:56:59
Filed Under: Health News, Nation News
CHICAGO (Oct. 17) - More than 90,000 Americans get potentially deadly infections each year from a drug-resistant staph "superbug," the government reported in its first overall estimate of invasive disease caused by the germ.
Deaths tied to these infections may exceed those caused by AIDS, said one public health expert commenting on the new study. Tuesday's report shows just how far one form of the staph germ has spread beyond its traditional hospital setting.
The overall incidence rate was about 32 invasive infections per 100,000 people. That's an "astounding" figure, said an editorial in Wednesday's Journal of the American Medical Association, which published the study.
Most drug-resistant staph cases are mild skin infections. But this study focused on invasive infections - those that enter the bloodstream or destroy flesh and can turn deadly.
Researchers found that only about one-quarter involved hospitalized patients. However, more than half were in the health care system - people who had recently had surgery or were on kidney dialysis, for example. Open wounds and exposure to medical equipment are major ways the bug spreads.
In recent years, the resistant germ has become more common in hospitals and it has been spreading through prisons, gyms and locker rooms, and in poor urban neighborhoods.
The new study offers the broadest look yet at the pervasiveness of the most severe infections caused by the bug, called methicillin-resistant Staphylococcus aureus, or MRSA. These bacteria can be carried by healthy people, living on their skin or in their noses.
An invasive form of the disease is being blamed for the death Monday of a 17-year-old Virginia high school senior. Doctors said the germ had spread to his kidneys, liver, lungs and muscles around his heart.
The researchers' estimates are extrapolated from 2005 surveillance data from nine mostly urban regions considered representative of the country. There were 5,287 invasive infections reported that year in people living in those regions, which would translate to an estimated 94,360 cases nationally, the researchers said.
Most cases were life-threatening bloodstream infections. However, about 10 percent involved so-called flesh-eating disease, according to the study led by researchers at the federal Centers for Disease Control and Prevention.
There were 988 reported deaths among infected people in the study, for a rate of 6.3 per 100,000. That would translate to 18,650 deaths annually, although the researchers don't know if MRSA was the cause in all cases.
If these deaths all were related to staph infections, the total would exceed other better-known causes of death including AIDS - which killed an estimated 17,011 Americans in 2005 - said Dr. Elizabeth Bancroft of the Los Angeles County Health Department, the editorial author.
The results underscore the need for better prevention measures. That includes curbing the overuse of antibiotics and improving hand-washing and other hygiene procedures among hospital workers, said the CDC's Dr. Scott Fridkin, a study co-author.
Some hospitals have drastically cut infections by first isolating new patients until they are screened for MRSA.
The bacteria don't respond to penicillin-related antibiotics once commonly used to treat them, partly because of overuse. They can be treated with other drugs but health officials worry that their overuse could cause the germ to become resistant to those, too.
A survey earlier this year suggested that MRSA infections, including noninvasive mild forms, affect 46 out of every 1,000 U.S. hospital and nursing home patients - or as many as 5 percent. These patients are vulnerable because of open wounds and invasive medical equipment that can help the germ spread.
Dr. Buddy Creech, an infectious disease specialist at Vanderbilt University, said the JAMA study emphasizes the broad scope of the drug-resistant staph "epidemic," and highlights the need for a vaccine, which he called "the holy grail of staphylococcal research."
The regions studied were: the Atlanta metropolitan area; Baltimore, Connecticut; Davidson County, Tenn.; the Denver metropolitan area; Monroe County, NY; the Portland, Ore. metropolitan area; Ramsey County, Minn.; and the San Francisco metropolitan area.
Copyright 2007 The Associated Press
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That. Is so scary. I have had staph. It is VERY resistant. Thank goodness they caught it in time. That was the first time I had peritonitis (3 times in one year). Now, every time I go to the hospital for something I will be thinking of this..
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Note this article from 2004. Robin Mirrlees and I have been fighting this on both sides of the pond.
Why is the US so far behind on this issue. The "Superbug" has made TV news
here in central florida in the last two days.So we are about 3 years behind
the UK on this and other Hospital Borne Infections..............bd
24 October 2004
KILLER ON WARDS: KNOT ON!
Doctors are told to keep their ties tucked away to beat deadly MRSA bug
By Mike Merritt And Himaya Quasem
DOCTORS are being ordered to tuck in their ties to stop the spread of killer
MRSA.
New NHS guidelines have labelled the neckwear a major hygiene risk.
Experts say they harbour massive amounts of germs, including the deadly MRSA
bug.
But victims of MRSA say such measures are only a fraction of what needs to
be done.
And one, colourful laird Count Robin de la Lanne Mirrlees, says doctors
should be banned from wearing ties entirely.
He believes he was infected by the medics' ties when he was in Hammersmith
Hospital, London, being treated for a stroke in February.
The count, who owns the island of Great Bernera in the Outer Hebrides and is
a friend of actress Joanna Lumley, said: 'Doctors should be banned from
wearing ties in hospital. It is a health hazard.
'The doctors who treated me all had their big ties flapping over me. God
knows how many patients' germs they were carrying. If they need to wear any form
of tie they should wear bow ties.'
Margaret McReight, 68, and her husband Robert, 74, both contracted MRSA
after treatment at the Royal Infirmary in Edinburgh.
Robert, from Edinburgh, was being treated for a blocked artery but ended up
losing his leg because of MRSA. And Margaret caught MRSA while being treated
for a broken leg.
Margaret said: 'I remember drops of blood from my dressing falling on the
floor.
'They were cleaned three weeks later when I was being discharged.
It's all very well getting doctors to tuck away their ties but there are
more basic hygiene standards that need to be meet.'
A spokesman for the Scottish Centre for Infection and Environmental Health
said: 'It would surprise me if there were no germs on ties.
'While doctors may wash their hands in between examining patients, they
cannot wash their ties each time. The only real safe way is not to wear them.'
In July, the Sunday Mail revealed three of Scotland's biggest hospitals -
Glasgow's Victoria, Ninewells in Dundee and Aberdeen Royal - were riddled with
MRSA.
Prof Hugh Pennington, the UK's leading hygiene expert, said: 'In a lot of
cases, our slaughterhouses are cleaner than our hospitals.'
While contaminated ties brushing against patients pose a risk, experts
maintain poor hand hygiene and failure to wash medical instruments properly are
the biggest cause of bugs spreading.
An Executive spokesman said last night: 'We are aware of the risk and the
guidelines make it clear that all ties should not be loose.
'Obviously, wearing ties adds to a smart appearance but if they are loose
there could be a hygiene risk.'
_http://www.sundaymahttp://wwhttp://www.sundahttp://wwwhttp://wwhttp://www.sun
http://www.sundahttp://www.http://www.shttp://wwhttp://ww_
(http://www.sundaymail.co.uk/news/tm_objectid=14790789&method=full&siteid=86024&headline=killer-o
n-wards--knot-on--name_page.html)
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I'm also in Florida but on the other end of the stick. I'm a dialysis RN. Got into this area after the death of my husband who was a donor and have been able to keep contact regarding how his reciepents are progressing for the last 10 years now. Our clinic cleans with 1:100 bleach solution outside of machines, chairs, tv, b/p cuff and any external surface within pt/staff reach after each pt. If blood actively present then it's 1:10 bleach solution. We also acetic acid and also bleach internal of machines every night when the last pt comes off. I work a 14 chair unit where right now I am the only RN on staff besides the FA. We run 3 shifts the first pt starting at 5:30am. I was just informed this past week we are CUTTING staff even more and I will not only continue being charge nurse but the only nurse and 2 pcts to run the day. I may get lucky for a 3rd to come in around 10am if corporate gives permission based on the little paper we fax now every am to get approval for the staff hours. I have pts from several nursing homes that are stretcher bound and it hit me hard last week when I had to call and apologize as I had to send one of these pts out after dialysis in a big MESS so to speak. She had her "accident" within 10 min of her blood hitting the dialyzer with a 3 1/2 hour run to go. We have no wash cloths or towels in our clinic nor any privacy for pts such as these. I have nothing more than chuxs and paper towels and it's all that has ever been there since I started this clinic. Not only this but I didnt have the staff to clean her if I did have the materials. I have been with this company only 9 months and little do they know I am on my way out the door after this. I used to be the Infection control RN at a major hospital and this place just is scary!!! Yet it is considered the "better clinic" in my area. I see MRSA and other infections routinely of late and also have had to work ill myself exposing pts. Now this is a company who just recently reported a 33% profit ???? Ok, loose the clown nose and rid themselves of the pirate hats, forget the 2 day drunk at the academy and buy us some wash cloths and towels...oh not to mention STAFF!!!
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MSRA has been in both the national and state news for about the past two weeks.
One wonders why it took so long to bring this to public attention.
Poor staffing at clinics and hospitals is an issue that needs to be dealt with.
Same goes for sanitation.
Why aren't kidney organizations demanding meaninful action from state and national
legislators?
One RN for 10 or more patients should be illegal.
Techs should be at least CNA's and preferrably LPNs.
Dialysis patients' lives are at stake here.
........bd
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MSRA has been in both the national and state news for about the past two weeks.
One wonders why it took so long to bring this to public attention.
Poor staffing at clinics and hospitals is an issue that needs to be dealt with.
Same goes for sanitation.
Why aren't kidney organizations demanding meaninful action from state and national
legislators?
One RN for 10 or more patients should be illegal.
Techs should be at least CNA's and preferrably LPNs.
Dialysis patients' lives are at stake here.
........bd
Things just keep getting worse for us Hemo Dialysis patients here in Florida.
.....bd
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Jenna's neph said that there are a thousand less germs at home than in-clinic, making home hemo even more desirable.
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in my clinical in Conroe they never wipe the little televisions that the patients touch to change the channels
I asked why and I was told they don't care about the televisions (the Staff)
when I first started I had to tell the nurses that a dirty, bloody sheet had been in the trash can my last three visits ( restroom trash)
everytime I opened the trash can there it was and full of blood
I still saw it on the 4th visit and asked - who do I call to get this taken care of
I was answered with a - well the cleaning staff does not do a professional job
on the 5th visit and it was still like that I told the staff director and it was finally taken care of
one time there was diarrhea on our floor and I started walking down the hall to a restroom and they followed after me and told me to use the patient restroom anyway, we can't walk down the halls with needles
I was allowed and blessed to be allowed to use the staff restroom and it was so clean
I was told not to make it a habit
I said then clean our restrooms.....
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i once found a bedbug crawling merrily across the floor at my dialysis center in san francisco. eeewwwwww!!! i suppose this shouldn't have been so surprising since many of my fellow patients are hygienically challenged (due to age, mental capacity and/or living situation). our bathroom is also usually quite disgusting, a challenge mostly mitigated by the fact that i no longer urinate...
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Mine is absolutely perfect. My center is hospital based and all the staff are RN's and they change gloves everytime they move. We are even allowed to eat while dialyzing.
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Do you know that your local fast food joint (which is Gross) is scrutinized and inspected for cleanliness
and sanitation more closely and more often than your local hospital or clinic?
??? >:(
I find that quite infuriating