Can someone share their policies and practices regarding care of dialysis catheters? Our infection rate was up last month, and I'm wondering if we're using the best practice we can. We're a small (68-70 pts.) independent facility. I appreciate any input.

First, out pts. are instructed not to shower or bathe or touch their P/C.s When they get to the unit, we take off the old dressings, change gloves, cleanse the cath site with Chloroprep or Betadine swabs and wrap the ports with betadine wipes for 3-5 minutes. Change gloves. Hook them up. Change gloves. Apply tegaderm or gauze/tape to the cath site. During treatment pts. have a chuck under the site and a sterile gauze 4x4 under the catheter. After tx, we wrap the ports again with betadine 3-5 minutes. Change gloves. Apply new sterile 4x4. D/C lines. Change gloves. saline flush, heparinize, cap off, apply gauze and tape. Done. Temps are take pre- and post Tx, any s/s of infection pt. is given IV antibiotic. I think PPE and constant changing of gloves/washing hands has been the key to our low infection rates. We have a large amount of noncompliant clients, but we still manage to keep infections down. We also have a QC person monitoring our procedures regularly. Hope this helps!

Thanks, Rizenfly. This sounds pretty much like what we do EXCEPT the 3-5 minute betadine soaks. I know this is a practice I've seen in the past. Sounds like a good one. We'll give it a try. I appreciate any help with this.

The company I worked for changed P&P to use chlorhexidine instead of Betadine for catheter care (and peripheral access prep as well). Chlorhexidine does not require a lengthy soak time (which was frequently not followed in the rush-rush atmosphere of a chronic clinic); it is also a much better disinfectant. We saw our infection rates greatly improve after this switch.

Of course, not everyone follows P&P and good nursing practice - I saw nurses not using anything on the perm cath caps before opening them, and other careless practices that contribute to high infection rates (water never touched their hands*, and they may have changed gloves once between patients and touched absolutely everything - including the trash can - before continuing with the same patient ... but that's another sad topic). However, look for patterns if you have permanent assignments in your clinic and the patients assigned to certain nurses have the highest infection rates.

HTH,

DeLana :)

*the company did not provide alcohol-based hand disinfectants either and even prohibited their use - go figure!

i think rizenfly and delana said it all--my only addition would be that having a access manager helps alot--they track all new accesses, when caths were placed, when to start new fistulas..etc. reminding pts to please not get their sites wet, y'all know what i'm talking about. that whole hand washing and not changing gloves is a constant battle @ my unit. most of all is to get that cath out of there as quickly as you can, if possible.

The company I worked for changed P&P to use chlorhexidine instead of Betadine for catheter care (and peripheral access prep as well). Chlorhexidine does not require a lengthy soak time (which was frequently not followed in the rush-rush atmosphere of a chronic clinic); it is also a much better disinfectant. We saw our infection rates greatly improve after this switch.

Of course, not everyone follows P&P and good nursing practice - I saw nurses not using anything on the perm cath caps before opening them, and other careless practices that contribute to high infection rates (water never touched their hands*, and they may have changed gloves once between patients and touched absolutely everything - including the trash can - before continuing with the same patient ... but that's another sad topic). However, look for patterns if you have permanent assignments in your clinic and the patients assigned to certain nurses have the highest infection rates.

HTH,

DeLana :)

*the company did not provide alcohol-based hand disinfectants either and even prohibited their use - go figure!

Just curious as to whether this place gave any reasoning as to why they do not provide alcohol-based hand rubs. The CDC recommends the use of alcohol-based hand rubs as long as the hands are not soiled because (compared to hand washing) it is faster, more effective, more accessible, reduces bacterial counts on hands, and is less drying. Here are their guidelines:

http://www.cdc.gov/od/oc/media/pressrel/fs021025.htm

This place sounds like it is very poorly managed based on what you have said and they should be reported to some higher authority. Patients lives are in danger because of the poor patient safety practices occuring there.

Yes, I was aware of the CDC guidelines regarding alcohol-based hand disinfectants; therefore I bought and brought my own, which I used in addition to washing my hands whenever I could. I was shown P&P as a result - and kept my disinfectant in my pocket after that (I would refill it from a large bottle I kept in my locker.)

This was at a large, national for-profit company which had always had excellent policies up to that point; it made absolutely no sense to me. The only thing I could even guess: they knew that in the rush-rush atmosphere of a dialysis clinic hand-washing is at best shortened (I know I couldn't take 30 seconds, but did the best I could) and were afraid if they provided the gels then nobody would ever wash their hands again?!

Basically, it makes no sense; I fully agree. I haven't worked there in nearly 2 years now and have no idea if things have changed since the merger.

Other than that strange policy the company's infection control P&P was fine (and hand washing should be sufficient if it's done); the problems were individual nurses and UAPs. Why were they kept on staff? Well, that's a whole other topic - among other reasons, HD is not a very popular field for nurses to go into; turnover is a major problem (and not just between shifts ). Sometimes I thought they would rather retain the poor performers than have nobody at all to dialyze the patients? Who knows, I'm only guessing here - but I'm certainly not returning to such an environment.

DeLana

P.S. If they "didn't know" who their poor performers were, then they simply didn't look. But if I knew, certainly the manager (who worked the floor before getting promoted) knew. After all, she certainly spotted the contraband - my hand disinfectant - immediately