Patients were exposed to hepatitis B because nurses lacked access to electronic medic

[Chisca, RN]

Appalling story out of Boston about patients exposed to Hep B because staff did not follow basic procedures in screening and cleaning machines. Do hospitals abrogate their responsibilities to patients just because they contract out dialysis services?

http://www.boston.com/whitecoatnotes/blogs/white-coat-notes/2013/08/01/patients-were-exposed-hepatitis-because-nurses-lacked-access-electronic-medical-records/LUA8CenF0AOERyfnEmEebO/blog.html

[westieluv]

That is horrible.

I work for Fresenius and, at least in our area, we are vigilant about Hep B screening. If we don't have actual, printed results from the lab that drew them, we assume that a patient is infected and bleach the machine each and every time after their treatment. We do not accept results that are more than 30 days old either. After reading this article, I am glad to work for a unit that is this cautious!

[Cessna172]

What tubing is reused for dialysis machines? It's been a very long time since I have seen it, but I thought the complete circuit was changed. Could someone please enlighten me? Thanks.

[westieluv]

The external blood tubing is disposable and intended to be used for only one treatment and then tossed, but the interior tubing of the machine that is not disposable but a part of the internal workings of the machine gets cleaned with vinegar and/or bleach routinely per company policy under normal circumstances (e.g. patients have no communicable diseases) and should always be cleaned with bleach after use by a patient whose Hep B status is unknown or not verified by the lab. This is the dialysate tubing so it does not normally come in direct contact with the patient's blood, but it still needs sanitized per company protocol.

[Chisca, RN]

It amazes me that so many links were broken in this event. What kind of unit culture exists where you are knowingly breaking so many rules that a machine can go almost two weeks without proper disinfection? Hepatitis B is a very hardy virus and can exist as a viable entity for weeks. Any droplet of blood on the machine or in the circuits risked the next patient that used that machine. In my unit the logs are right with the machine and easily checked.

I am also facinated by the idea in hospital management that certain services can be contracted out absolving them of some of the responsibility for quality and safety. I have worked as an agency nurse in a variety of hospitals, as an ICU nurse, but there was always that one hospital where so many agency nurses were in the staff mix that care suffered. I would never want to be a patient in a hospital where 80 percent of the staff is agency. With contracting it becomes 100%. What is is it about hemodialysis that makes hospitals comfortable with the idea of farming out this specialty?

The excuse the staff "didn't have access to the electronic record" begs the question what other lab values did they not know about? Were patients being run without knowlege of potassium or bicarb levels? When the nurses employed by the hospital gave a handoff couldn't the dialyis nurse have asked for these values? Or did they just not care?

[westieluv]

Our machine logs stay with the machines at all times too, and we are vigilant about bleaching and heat disinfecting per our company's protocol.

Not having access to the electronic record is a lousy excuse and undoubtedly one that would not stand up in court. Either get access or refuse to dialyze patients until you do, it's really not that hard.

We are contracted in one of those long-term acute care hospitals and the conditions there are pretty bad. We are always made to draw our own labs in the morning and then have to wait for them to be run by the one lab tech that they employ. The excuse that they give why their staff do not draw labs is always, "Well, the nurse was an agency nurse who isn't good at drawing blood so she didn't get it," because this facility cannot keep staff and uses agency nurses at least 50% of the time. This facility sends its Hep B draws out to a larger hospital with an efficient lab, but we still have to call that facility and get something faxed over from them that shows the negative Hep B results or plan on bleaching after the patient every time. Word of mouth (especially from this place's staff!) or just not knowing is never an excuse.

[Erikadawn RN]

I work in dialysis and we are contract in a hospital, I don't understand how a machine could go for 2 weeks without being bleached. I for a time worked for Davita and they most definitely violated company policy. We treat all unknown Hep B individuals as if they are infected. Not bleaching a machine for 2 weeks, Wow! That has nothing to do with not being able to gain access to medical records