Part Three

- Taking care of the hemodialysis machine

Steps:

◾   Wear personal protection.

◾   Remove the solution stick from the jerry can and place it in the machine

◾  Connecting the dialysis tubes to the machine

◾   Ensure that all doors (pump, blood tank) are closed to create a closed circuit (Rinse).

◾   Enter a program first.

◾   Enter the machine into the Dis infection program.

◾   Apply the necessary solution to the machine: chlorine solution in cases of acetate washing and citric solution in cases of bicarb washing

◾   Shut down the machine after the machine finishes the program

◾   Wipe the machine from the outside with chlorine diluted at a rate of 100 cm chlorine / liter of water for the body of the machine.

◾    Wipe the parts of all operating switches with 95% alcohol

Sterilization protocol for the Fresenus dialysis machine, model 8004

First: In the case of washing using Acetate solution.

◾   Rinse is done between each session.

◾   At the end of the day (and every day), one of two methods is followed

The first method:

◾   Performing PGM5 cold chemical disinfection using sodium hypochlorite diluted by 10%.

◾   Trade name (Javel or Clorox)

◾   Conducting a thermal disinfection program. Hot Rinse Pgm

The second method:

Perform hot chemical disinfection on PGM2 (from the back, yellow link) using one of the following media:

◾   Fresenius Diasteril

◾   Fresenius Citrosteril

NB :

Devices equipped with Diasafe Filter are chemically disinfected using PGM2 – (rear yellow link Fresenius Diateril only)

Second: In the case of washing using a solution (using: Bicarbonate

One of the following two methods is followed:

First method:

Immediately after each bicarbonate washing session, calcifications (calcium salt deposits) are removed and the machine is chemically disinfected from the back of PGM2 using one of the following media:

Fresenius Diasteril

Fresenius Citrosteril

The second method:

Immediately after each bicarbonate washing session, calcifications (calcium salt deposits) are removed using

PGM2 from the back (yellow link) is diluted using Citric Acid Concentrate

100% 10g citric per liter of water from the water treatment unit.

.   At the end of the day and every day, a cold chemical disinfection (PGM5) is performed using the chemical agent sodium hypochlorite diluted by 10% (trade name: Javel or Clorox).

NB :

Devices equipped with Diasafe Filter    are chemically disinfected with PGM2 on the back

Yellow link using the agent Diasteril. Fresenius only

Procedures during a peritoneal dialysis session

Steps:

◾    Explaining the procedure in a simple way, which helps with psychological stimulation.

◾    Routine hand washing.

◾    Wear protective clothing.

◾    Preparing medical supplies

◾    Hand washing is surgical

◾    Sterilize the abdominal skin with Betadine, taking into account the contact time

◾    Assistance in injecting a local anesthetic (Xylocaine) into the selected area in the lower abdomen

◾    Assist in installing the peritoneal catheter and ensuring its placement by the doctor

◾    Nursing staff should handle the patient and the connections in a sterile manner

◾    Place a bottle of washing solution, whether concentrated or diluted, depending on the patient’s condition, inside the peritoneal cavity over a quarter of an hour.

◾    Continue leaving the solution for 55 minutes, then empty it over the course of a quarter of an hour

◾    Put heparin and the antibiotic in the lubricants or solution used according to the doctor’s instructions

◾    Safe disposal of waste

◾    Routine hand washing

Isolating the patient in the unit

Steps:

.   The unit supervisor isolates each of the hepatitis B5 patients individually in an isolation room. HCV/HBV patients

.   Isolating patients physically (in a separate room from the rest of the patients)

.   Allocating their own machines, special supplies and tools, and their own nursing staff who do not deal with the rest of the patients during the dialysis session.

.   Follow all infection control procedures during each procedure.

Doing monthly tests

Steps:

.    Visit the patient with the doctor and determine the type of tests required.

.   Continue writing analyses

.    Explain the procedure in a simple way to the patient

.    Prepare special tubes for the sample type.

.    Collect samples while following infection control instructions

.    Send the sample to the laboratory

.    The results of the tests are brought from the laboratory by the medical secretariat

.    Informing the doctor of the results and recording them in his patient file and the analysis notebook

.    Giving a copy of the test permit to the accounting employee to place in the patient’s file

.    Presenting monthly analyzes to the unit manager