PD Ettiquete

[Deanne]

Thanks for all of these! As a newbie, I was a little worried that I'm not doing things right. I'm very careful, but I have my dogs on the bed while I connect/disconnect. One dog is always burrowed under a blanket and I make sure my other one is blocked by my body so he isn't breathing on anything. I don't close the door, and when I disconnect in the morning, I don't mask or get up to wash my hands first. There's no time for all of that - one of the dogs won't wait go go out. If I don't move my rear, he'll pee in bed. I bought some antibacterial hand wipes to use instead, and I use hand sanitizer. I'm always very careful about where I touch and my center sent me home with some sort of antibacterial cleaner stuff I use on the connections before connecting/disconnecting.

[Grumpy-1]

Deanne  Please be careful in your routine of disconnecting.  I did basically what you say you do, but just cause I was lazy.  It cost me using PD. After a number of infections, I had too scar tissue for PD to work and now having to go back to Hemo.  Been in center for all most a year as they tried to put a good PD access in and get it working.  NO luck.  Now waiting for a fistula creation date with the surgeon.  Grumpy

[Weggy]

I used to follow the 'routine' described by my PD nurse. After some thought and discussion with my nurse (she is old school), I really only follow two things.

1. Remove/minimize air flow in the room where you hook up. My reasoning and my nurses reasoning is this: bacteria are not going to magically crawl or jump from one area to another. The fastest way of travel is in the air or direct contact. Wearing a mask, closing windows, closing the door and turning off the AC/heat/fan eliminates the air travel.

2. If anything touches the sterile parts, it gets thrown away or if it is on my catheter it gets a new cap put on it to sterilize it again.

I keep my dog in my bedroom when I hook up and my fiancee doesn't wear a mask either. She is far enough away that it won't matter. I just reiterate that she cannot move since that disturbs the air. Same for coughing or sneezing.

My nurse is fine with my decisions since I explained why I think this way. Basically, bacteria is not going to just crawl or magically jump to your catheter or any sterile ends. The form of transfer is going to be either direct contact or from the air. I told my nurse that the routine was created to give patients a routine to follow. It is easier to teach someone repetitive steps rather than concepts.

[obsidianom]

Wearing a mask at least on yourself is critical . Numerous studies have shown a high level of staph bacteria in the nostrils of dialysis patients , and breathing on your sterile areas is asking for trouble. We even mask up now to change the dressing on the fistula in my wifes arm. Anything to min imize the risk of an infection. Infections are no fun and can lead to numerous complications.
Since you dont have time to thoroughly wash your hands, what about gloves? At least you minimize the risk .

[Deanne]

I'll be more careful with the mask in the mornings. I thought about gloves, but are they cleaner than hands after I've throughly used anti-bacterial hand wipes and hand sanitizer? I was thinking about gloves sitting in a box while bacteria float around near them. I'm trying to find the best way to be safe while being practical in getting the dog to the door before he pees in bed or on the floor. Bella (my other dog) uses a dog door and isn't a problem, but Tigger is blind and not very bright. I need to show him where the door is every day and when he needs to go, he needs to go NOW, so speed is important. The door can be wide open and he'll pee in the room right in front of the door.

[obsidianom]

I'll be more careful with the mask in the mornings. I thought about gloves, but are they cleaner than hands after I've throughly used anti-bacterial hand wipes and hand sanitizer? I was thinking about gloves sitting in a box while bacteria float around near them. I'm trying to find the best way to be safe while being practical in getting the dog to the door before he pees in bed or on the floor. Bella (my other dog) uses a dog door and isn't a problem, but Tigger is blind and not very bright. I need to show him where the door is every day and when he needs to go, he needs to go NOW, so speed is important. The door can be wide open and he'll pee in the room right in front of the door.

I have thought about the whole non sterile glove thing myself a lot. I guess the bottom line is dialysis patients have a lot of staph on their skin and even washing with anti bacterial soap only washes away part of it. You would need a full 5 to 10 minute wash llike we do before going into the operating room to really clean the hands enough to be safe. Also anti bacterial soap creates resistant bacteria that survive and are more dangerous. The gloves at least are clean and generally dont contain staph or resistant bugs. They are safer than just washing hands. As you are in a hurry it really makes more sense to quickly wipe with the hand wipes and then put on gloves . You can do that in seconds and be so much safer than you are now.
I am a dog person too and can sympathize with what you are saying. try the approach I just gave you and i think you and your dogs will be happy.

You may also want to cover the box of gloves after you open it. That will keep it cleaner.

[Deanne]

Thanks! I'll go buy gloves.

[Shaks24]

Just curious. Why is that dialysis patients are high in staph  infection. I did not know this. Is it because we are in and out of clinics so much or is it part of the ersd?

[obsidianom]

Just curious. Why is that dialysis patients are high in staph  infection. I did not know this. Is it because we are in and out of clinics so much or is it part of the ersd?

I beleive it is due to altered immune function . Staph is common anyway and most of us just deal with it naturally through our immune function . With dialysis the ESRD has reached a point where the immune system is compromised and staph can multiple easily. In addition many patients also have diabetes which is another immuno compromisisng disorder.
Bottom line is we all need to be extra careful of infections. It is doable with good washing and use of gloves and masks.

[obsidianom]

Just curious. Why is that dialysis patients are high in staph  infection. I did not know this. Is it because we are in and out of clinics so much or is it part of the ersd?

I beleive it is due to altered immune function . Staph is common anyway and most of us just deal with it naturally through our immune function . With dialysis the ESRD has reached a point where the immune system is compromised and staph can multiple easily. In addition many patients also have diabetes which is another immuno compromisisng disorder.
Bottom line is we all need to be extra careful of infections. It is doable with good washing and use of gloves and masks.

BMC Infect Dis. 2012 Nov 1;12:284. doi: 10.1186/1471-2334-12-284.

Methicillin-resistant Staphylococcus aureus nasal carriage among patients receiving hemodialysis in Taiwan: prevalence rate, molecular characterization and de-colonization.

Kang YC, Tai WC, Yu CC, Kang JH, Huang YC.


Source

College of Medicine, Chang Gung University, Kweishan, Taoyuan, Taiwan.


Abstract


BACKGROUND:

Staphylococcus aureus, particularly methicillin resistant (MRSA), is a common pathogen among patients receiving hemodialysis.

(This is abstract from one article pertaining to the issue).

[obsidianom]

Clin Vaccine Immunol. 2012 Sep;19(9):1509-16. doi: 10.1128/CVI.00034-12. Epub 2012 Jul 25.

Phase IIa study of the immunogenicity and safety of the novel Staphylococcus aureus vaccine V710 in adults with end-stage renal disease receiving hemodialysis.

Moustafa M, Aronoff GR, Chandran C, Hartzel JS, Smugar SS, Galphin CM, Mailloux LU, Brown E, Dinubile MJ, Kartsonis NA, Guris D.


Source

South Carolina Nephrology & Hypertension Center, Orangeburg, SC, USA.


Abstract


Bacteremia is the second leading cause of death in patients with end-stage renal disease who are on hemodialysis. A vaccine eliciting long-term immune responses against Staphylococcus aureus in patients on chronic hemodialysis may reduce the incidence of bacteremia and its complications in these patients. V710 is a vaccine containing iron surface determinant B (IsdB), a highly conserved S. aureus surface protein, which has been shown to be immunogenic in healthy subjects. In this blinded


(This shows how seriously medical science is taking the issue. Staph in dialysis patients is a major issue so vaccines are being developed to reduce the effect)

[obsidianom]

This article discusses the way the mix of fungal infections and staph bacteria which is common , can damage the patients immunity and lead to peritonitis in PERITONEAL DIALYSIS PATIENTS.  The damn bacteria and fungus work together synergistically to stop the normal defenses in the body. Just another example of what we are dealing with .



Infect Immun. 2013 Jun;81(6):2178-89. doi: 10.1128/IAI.00265-13. Epub 2013 Apr 1.

Candida albicans-Staphylococcus aureus polymicrobial peritonitis modulates host innate immunity

[obsidianom]

CONCLUSION:

Taken together our results show, for the first time, that HD patients present a different immune-pattern compared to the un-dialyzed CKD patients. Among the selected genes, some of them encode for important biological elements involved in proliferation/activation of cytotoxic effector lymphocytes and in the immune-inflammatory cellular machinery


This article discussed the effects of ESRD and dialysis on the immune system. It is clearly effected.
This is my last post on this, and I hope I DIDNT OVERDO IT. I just wanted to help answer the question posted about why staph is an issue in dialysis patients. The more research I did the more I found. It is clear we need a vaccine for staph to be finished soon. That would reduce morbidity and mortality greatly in ESRD. < especially in dialysis. In the meantime WASH and COVER as best you can .

[MaryD]

Certainly not overdone.  You are no doubt better at finding this sort of information than I am, and the more information the better - even if it's still in the early stage of an investigation.

Thank you     

[Shaks24]

Thanks Doc. Great information.

[Grumpy-1]

Thank Doc - It is nice to have you on the forum.  You bring allow of great information (from your view point).     Grumpy

[Uptownlifer]

Some good stuff in this thread, I have been on PD since December of 2013, and got peritonitis just last month.i can tell you I deviated from what I was trained to do. Now I wear the mask, wash the hands, use the sanitizer pump after each and every step of my preparation for nightly treatments. I also wipe my catheter connection with alcohol prep pads before removing the cap and connecting to the cycler. And in the morning, before disconnecting from the cycler I wipe it again with an alcohol prep pad before connecting to the cap.

[Charlie B53]

9 months on PD so far, so good, no infections, yet.

Religiously used the sanitizer gel.  If I adjust my mask or touch anything, I re-apply the gel.

I don't take off my dressing before the shower, but change it immediately after, using Mupirocin ointment just around the actual site, covering that with the 2X2 slit patch then the regular 2X2 over that.  I really like the cover-roll stretch tape but I occasionally get a 'water blister' from the tape unless I remember to paint the area with one of the iodine wipes.