Hand Hygiene in Haemodialysis Units

Healthcare-associated infections are a major risk to patient safety. Infection is the first cause of hospitalisation and the second most common cause of mortality among haemodialysis (HD) patients. HD patients, as well as the dialysis staff, are vulnerable to contracting healthcare-associated infections due to frequent and prolonged exposures to many possible contaminants in the dialysis environment. The extracorporeal nature of the therapy, the associated common environmental conditions, and the immune compromised status of HD patients are major predisposing factors. HD patients are exposed to different types of infections which include bloodstream infections and localized infections of the vascular access, blood-borne infections with hepatitis B virus, hepatitis C virus, and/or human immunodeficiency virus, and airborne infections. Sources of infections include contaminated water, equipment, environmental surfaces, and infected patients. The evident increased potential for transmission of infections in the HD settings led to the creation and implementation of specific and stricter infection prevention and control measures in addition to the usual standard precautions. Contaminated hands of healthcare workers are among the most common modes of transmission of healthcare-associated infections. Hand hygiene is singled out as the most important infection prevention intervention. Hand hygiene compliance can be improved by continuous education and monitoring, providing a sufficient number of sinks with soap dispensers, paper towels, hand lotions and alcohol-based hand rub placed at each patient station, and regular feedback of surveillance results. Education and training and full awareness of infection control policies and procedures should be provided to all Healthcare workers and to be repeated regularly. The patient and/or caregiver should also be educated on hand hygiene and the care of new vascular access.