428 SCOPE Collaborative Dialysis Infection Prevention Rounding Tool Surveyor Date 1 SPECIAL CONSIDERATIONS ROUNDING TOOL Screening and Precautions Illness Screening Notes Patients, parents/caregivers,[.]
A M Onder and M J G Somers 428 SCOPE Collaborative Dialysis Infection Prevention Rounding Tool SPECIAL CONSIDERATIONS ROUNDING TOOL Screening and Precautions Illness Screening Yes No Patients, parents/caregivers, and visitors are screened daily for contagious illnesses upon arrival to clinic AND includes the following components: Questions about exposure to illness ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ Fever or rash present Cough/Upper Respiratory Infection ☐ Yes No Isolation Considerations N/A ☐ N/A Hepatitis Bstatus confirmed (prior to initiation of dialysis treatment, when feasible) and positive patients are properly isolated with dedicated machine and nurse/tech ☐ ☐ ☐ Hepatitis unknown status patients (e.g those awaiting results) in isolation pending results ☐ ☐ ☐ Appropriate isolation signage is available and followed as indicated ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ No N/A Machine chemical disinfection after each treatment of Hepatitis B confirmed or unknown status Bleach disinfection procedure performed before machine returned to general patient use Notes Notes Environmental Considerations Privacy Curtain Yes Free of stains or tears Avoiding touching with dirty gloves/hands Hand hygiene performed immediately before and after touching the curtains Changed on schedule per manufacturer’s recommendations or institution policy/procedure Surveyor: Date: Fig 24.7 Infection prevention special considerations rounding tool Various factors relating to illness screening for patients, staff, or visitors and certain environment of care parameters can impact infection risk in the dialysis unit and warrant special consideration for inclusion in ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ Notes ☐ dialysis unit surveillance This rounding tool covers such special considerations (Rounding tool shared with permission: Standardizing Care to Improve Outcomes in Pediatric End Stage Renal Disease (SCOPE) Collaborative, Children’s Hospital Association) 24 Infectious Complications of Hemodialysis in Children Fig 24.8 Strategies for prevention of hemodialysis catheter infections Various factors relating to the patient and family, the hemodialysis staff, and the approach to chronic care of the catheter and exit site influence the likelihood of a catheter-related infection Successful mitigation of infections generally requires attention to multiple factors across these domains (Modified from: Fischer et al [101]) Patient and family education 429 • Share information early and often as to risk of long-term catheter use and benefits of AVF • Consider peritoneal dialysis as alternate dialysis modality • Discuss importance of transplant evaluation if candidate • Ongoing education on catheter care at home Hemodialysis staff • Track and trend infections with comparison to benchmarks • Audit handwashing • Audit exit site care • Audit catheter connection and disconnection • Ongoing staff education and competency testing Exit site care • Skin antisepsis with chlorhexidine-alcohol, povidone-iodine, or 70% alcohol during dressing changes • Use of povidone-iodine or polysporin triple antibiotic topical oinment during dressing changes OR use of chlorhexidine-impregnated dressing Catheter care • Catheter hub disinfection with chlorhexidine alcohol, povidone-iodine, or 70% alcohol with any connection/disconnection Transmission of infection from dialysis equipment or between dialysis patients is uncommon when standard infection control practices are followed References Shroff R, Calder F, Bakkaloglu S, Nagler EV, Stuart S, Stronach L, Schmitt CP, Heckert KH, Bourquelot P, Wagner AM, Paglialonga F, Mitra S, Stefanidis CJ on behalf of the European Society for Pediatric Nephrology Dialysis Working Group Vascular access in children requiring maintenance haemodialysis: a consensus document by the European Society for Paediatric Nephrology Dialysis Working Group Nephrol Dial Transplant 2019;34:1–20 Borzych-Duzalka D, Shroff R, Ariceta G, Yap YC, Paglialonga F, Xu H, Kang HG, Thumfart J, Aysun KB, Stefanidis CJ, Fila M, Sever L, Vondrak K, Szabo AJ, Szczepanska M, Ranchin B, Holtta T, Zaloszyc A, Bilge I, Warady BA, Schaefer F, Schmitt CP. 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