Proper Environmental Disinfection: A Basic Patient Safety ExpectationPosted on by
Author – Priti Patel, MD, MPH
CDC, Division of Healthcare Quality Promotion
Imagine walking into an operating room and seeing staff disinfect the room and open up sterile equipment for the next surgery while a patient is still on the table completing their procedure. Most of us would find this strange and unacceptable. Yet it happens every day in dialysis centers across the country, where it has become the norm to clean dialysis stations and set up machines for the next patient while a patient is still sitting in the chair completing their treatment. The staff who clean up the area are doing so while they are also helping a patient finish dialysis treatment, a time when patients can bleed for some time before they are ready to go home.
It’s not hard to see how this kind of multitasking for efficiency can lead to cross contamination (i.e., contamination of one patient’s medical supplies with blood or organisms from another patient). Such practices have been identified by CDC as dangerous and potentially contribute to outbreaks. Anecdotally, we have heard from dialysis center staff that the pressure they feel to get patients in and out of the stations quickly can interfere with more than just their ability to properly clean the stations. In some instances, proper hand hygiene and even medication preparation practices can suffer when they are under such intense time constraints.
The best practice is to wait until each patient has finished their treatment and can be safely discharged from the station before initiating procedures to disinfect the station or prepare it for the next patient. For many dialysis centers, this will require a change in processes and a little patience. As the staff from Fletcher Allen Health Care have shown, it is possible. Other centers have shown the same thing with reassuring results—not only do patients appreciate the changes to make their environment safer, but staff may also value the additional time to properly perform their duties.
CDC has provided some tools to help centers make this transition, and we are working on additional ones. Patients should be able to come to dialysis and expect a properly cleaned treatment environment. We hope other dialysis centers will strive to meet this basic patient safety expectation.