Can blood infections be introduced by the dialysis techs?

[jo]

There are new techs everyday in the center who mess up sending the blood back in at the end of treatments mainly due to lack of training. Sometimes, they pull the tubes off without even closing off the clamps and the blood will ooze out. It is sad as I see these happen in the patients in the center. In hemodialysis, what are the procedures to be followed while unhooking the patient? Can someone explain to me? Since my mom has been having recurring blood infections, I want to make sure that those are not introduced from their lack of training in using the dialyzer properly and not following the instructions. Please let me know what are the things I should watch/check for in case they do something wrong.

[Simon Dog]

The blood circuit for in-center treatment is a sterile disposable (in those clinics that do not re-use filters, which at present, seems to be most clinics).   RE-use clinics re-use filters only on tthe same patient.   The dialysate circuit is sterlized once per shift, but the nature of the flow prevents pathogens from being ciruclated to the patient (or so I am told).  Even so, patients with Hep C or HIV are treated in the isolation room and their dialysate circuit sterilized after each treatment.

There is a reported 1/3 of 1% chance of a full time in-center patient contracting HepC in a given year despite these precautions.   My MD tells me Fresenius recently adopted a policy of paying for Harvoni (at $95K a treatment) for patients who get Hep C in center.

When treatments are properly done, blood will be flushed out of the circuit with saline keeping patient blood loss to a minimum.  The remaining solution is still blood contaminated and a light pink, and disposed of in a hazmat container (the bins with red bags in the center).

If you want to watch for stuff, look for techs always wearing gloves, and putting on a new pair right before disconnecting the patient.   If the patient has a catheter, make sure the tech and the patient wear a mask during the connect/disconnect part of the process.

[Michael Murphy]

Good advise about making sure the tech or nurse changes gloves between patients.  There was a case of a Fresinius patient who popped a needle which freaked a new tech so the needle was reinserted the patient then died of a blood borne staff infection.  If a needles pops it must be replaced with a new one.

[jo]

Thank you for the advice.

[Charlie B53]

I wouldn't be worried so much about possible infection during disconnections.  More likely contamination could occur during set up of the machine or the initial stick.

Strict attention to protocol must be followed to prevent the possibility of contamination.  If ever in doubt as to how clean your tech or the equipment call for an IMMEDIATE stop and demand the Nurse oversee what is happening.

[Simon Dog]

No needle involved in that case (if it's the one I am thinking of).  That was a case where a cath came disconnected.  Clinic policy was to discard the blood setup and not reconnect.  The tech didn't do this, presumably because this would require a blood loss incident report.   This sort of thing is much riskier with a cath because the infection goes right to the heart.    There was another case where a tech was convicted of intentionally injecting bleach into the circuit to kill patients.

But, you are right - if a needle "pops out", or has to be pulled out because of a missed stick, infilitration, etc. policy is to use another needle.  There is less risk a tech will skip this step because using an extra needle on a patient is not a "reportable incident" (which no tech or RN wants to be associated with).   Similarly, if there is an error and the needle accidently touches a non-sterile surface (for example, brushing it against the arm), it must be discarded and replaced with a sterile one.

Good advise about making sure the tech or nurse changes gloves between patients.  There was a case of a Fresinius patient who popped a needle which freaked a new tech so the needle was reinserted the patient then died of a blood borne staff infection.  If a needles pops it must be replaced with a new one.