Dialysis Center Safety Manual

Dialysis Center Workplace Hazards

Dialysis employees may encounter hazards that are uncommon or more concentrated than those found in many other outpatient healthcare settings.

Potential hazards include:

• Blood and other potentially infectious materials
• Needlesticks and contaminated sharps
• Vascular-access procedures
• Blood-contaminated dialysis equipment
• Bloodline connections and disconnections
• Blood spills and leaks
• Dialysis machine cleaning and disinfection
• Chemical disinfectants
• Dialysate concentrates and treatment chemicals
• Water-treatment equipment
• Medical waste
• Patient lifting and transfers
• Slips, trips, and falls
• Respiratory infections
• Hazardous medications
• Oxygen and compressed gases
• Electrical equipment
• Workplace violence
• Emergency patient conditions

Employees should receive training appropriate to their responsibilities and potential exposures.

Bloodborne Pathogens & Exposure Control

Blood exposure is a significant occupational hazard in hemodialysis because employees repeatedly access patients’ bloodstreams and work with equipment through which blood circulates.

The facility’s Exposure Control Plan should address employees with occupational exposure and include applicable measures such as:

• Exposure determination
• Universal Precautions
• Engineering controls
• Work-practice controls
• Personal protective equipment
• Safer medical devices
• Sharps safety
• Hepatitis B vaccination
• Housekeeping
• Regulated waste
• Employee training
• Exposure incident reporting
• Post-exposure evaluation and follow-up
• Recordkeeping

The Exposure Control Plan should be reviewed and updated as required and when procedures, equipment, or employee exposures change.

Vascular Access Safety

Hemodialysis may involve arteriovenous fistulas, grafts, or central venous catheters. Employees responsible for accessing or disconnecting vascular-access devices should be trained in applicable infection-control and exposure-prevention procedures.

Safe practices should address:

• Hand hygiene
• Aseptic technique
• Appropriate PPE
• Skin antisepsis
• Catheter hub disinfection
• Needle insertion and removal
• Bloodline connections
• Dressing changes
• Bleeding control
• Sharps disposal
• Prevention of blood contamination
• Recognition and reporting of exposure incidents

Supplies used for vascular-access procedures should be maintained and handled to minimize contamination.

Needlestick & Sharps Safety

Dialysis employees may routinely handle fistula needles, syringes, lancets, and other sharps.

Sharps-safety procedures should address:

• Use of appropriate safer medical devices
• Activation of safety features
• Safe needle handling
• Immediate disposal after use
• Accessible sharps containers
• Prevention of overfilled containers
• Prohibition of unsafe recapping practices
• Needlestick reporting
• Exposure evaluation
• Review of sharps injuries

Employees should never reach into sharps containers or attempt to retrieve discarded items.

Dialysis Station Infection Control

Each dialysis station can become contaminated with blood, body fluids, and microorganisms during treatment.

Procedures should establish clear practices for:

• Hand hygiene
• Glove use
• PPE
• Separation of clean and contaminated items
• Handling supplies brought to the station
• Medication practices
• Equipment cleaning
• Environmental disinfection
• Waste disposal
• Blood-spill response

Items taken into a dialysis station should be treated as potentially contaminated and should not be returned to clean supply areas unless appropriately cleaned and disinfected.

Dialysis Machine Safety

Dialysis machines should be operated only by employees who have received appropriate training.

Employees should follow established procedures for:

• Pre-treatment equipment checks
• Machine setup
• Bloodline installation
• Alarm response
• Blood-leak response
• Pressure monitoring
• Connection and disconnection
• Cleaning and disinfection
• Equipment maintenance
• Removal of malfunctioning equipment from service

Employees should not bypass alarms, guards, interlocks, or other equipment safety features.

Dialysis Machine Cleaning & Disinfection

Dialysis machines and associated surfaces should be cleaned and disinfected according to established procedures and manufacturer instructions.

Procedures should address:

• External machine surfaces
• Control panels
• Frequently touched surfaces
• Blood-contaminated areas
• Internal disinfection when applicable
• Appropriate disinfectants
• Required concentrations
• Contact times
• Employee PPE
• Chemical exposure
• Documentation when required

Cleaning should be performed in a manner that prevents contamination of clean supplies, medications, or adjacent treatment areas.

Blood Spills & Blood Leaks

Blood spills may occur during needle insertion or removal, bloodline disconnection, machine malfunction, access-site bleeding, or other treatment activities.

Employees should:

• Control access to the affected area.
• Wear appropriate PPE.
• Remove visible contamination safely.
• Use an appropriate disinfectant.
• Dispose of contaminated materials properly.
• Prevent contamination from spreading.
• Report significant exposures or equipment failures.

Employees should receive training in the facility’s blood-spill procedures before being assigned cleanup responsibilities.

Hand Hygiene

Hand hygiene is critical in dialysis settings because employees frequently move between patients, dialysis equipment, supplies, and environmental surfaces.

Employees should perform hand hygiene at appropriate times, including before and after patient contact, after glove removal, and after contact with contaminated equipment or surfaces.

Handwashing facilities and appropriate hand-hygiene products should be readily accessible.

Personal Protective Equipment

PPE should be selected based on anticipated exposure to blood, chemicals, infectious materials, and other hazards.

PPE may include:

• Examination gloves
• Chemical-resistant gloves
• Protective gowns
• Laboratory coats or protective clothing
• Eye protection
• Face shields
• Medical masks
• Respirators
• Chemical aprons
• Other task-specific protection

Employees should understand how to put on, remove, dispose of, clean, and store PPE without contaminating themselves or clean areas.

Cleaning, Disinfection & Environmental Surfaces

Dialysis chairs, beds, countertops, equipment surfaces, and other treatment-area surfaces should be cleaned and disinfected between patients as required by facility procedures.

Employees should understand:

• Which surfaces require cleaning
• Appropriate disinfectants
• Product dilution
• Contact times
• Required PPE
• Blood-contamination procedures
• Separation of clean and dirty activities
• Safe chemical handling

Cleaning materials should be managed to prevent cross-contamination between dialysis stations.

Dialysis Wall Boxes & Drain Areas

Dialysis wall boxes and drain connections can become contaminated and require appropriate cleaning and maintenance.

Employees assigned to work around these systems should understand:

• Contamination hazards
• Required PPE
• Cleaning procedures
• Disinfection procedures
• Splash prevention
• Proper equipment positioning
• Maintenance reporting
• Hand hygiene

Patient-care supplies should be protected from splash or contamination associated with drain and wall-box areas.

Water-Treatment System Safety

Hemodialysis depends on properly treated water. Dialysis facilities may use reverse-osmosis systems, filters, storage tanks, distribution loops, chemical-treatment equipment, and monitoring devices.

Only trained and authorized employees should operate, test, maintain, or service water-treatment systems.

Procedures may address:

• System monitoring
• Water-quality testing
• Equipment inspection
• Alarm response
• Chemical handling
• Disinfection
• Preventive maintenance
• Documentation
• Emergency response

Employees should promptly report abnormal readings, alarms, leaks, chemical conditions, or equipment malfunctions.

Dialysate & Chemical Concentrates

Dialysis operations may involve acid concentrates, bicarbonate concentrates, disinfectants, cleaning chemicals, and other products.

Employees should:

• Review labels and Safety Data Sheets.
• Follow mixing and handling procedures.
• Prevent incompatible chemical combinations.
• Wear required PPE.
• Use properly labeled containers.
• Prevent splashes.
• Store chemicals appropriately.
• Follow spill procedures.
• Maintain appropriate ventilation.

Chemical containers should not be used for purposes other than those for which they were intended.

Hazard Communication

Employees who work with hazardous chemicals should receive information and training under the facility’s Hazard Communication program.

The program should address:

• Chemical inventories
• Container labeling
• Safety Data Sheets
• Employee training
• Chemical hazards
• Protective measures
• Non-routine tasks
• Chemical spills
• Emergency procedures

Employees should know how to obtain hazard information before using an unfamiliar chemical.

Emergency Eyewashes & Safety Showers

Where corrosive or otherwise hazardous chemicals could expose employees’ eyes or bodies, appropriate emergency flushing equipment should be provided as required by the hazard.

Employees should know:

• Where emergency equipment is located
• How to activate it
• How long flushing may be necessary
• How to summon medical assistance
• How to report the exposure

Access to emergency equipment should remain unobstructed.

Medication Safety

Dialysis employees may prepare or administer anticoagulants, injectable medications, intravenous medications, or other drugs during treatment.

Medication-safety procedures should address:

• Preparation areas
• Aseptic practices
• Labeling
• Storage
• Single-dose and multidose containers
• Sharps
• Employee exposure
• Medication spills
• Waste disposal

Clean medication-preparation areas should be separated from contaminated treatment activities.

Medical Waste

Dialysis facilities may generate substantial quantities of sharps, blood-contaminated materials, tubing, dressings, and other medical waste.

Procedures should address:

• Waste identification
• Sharps containers
• Regulated-waste containers
• Container labeling
• Storage
• Internal transportation
• Employee handling
• Removal from the facility

Employees should not manually compress bags or place their hands into containers where hidden sharps may be present.

Respiratory Infection Prevention

Dialysis patients often spend extended periods in shared treatment areas, and employees may work in close contact with multiple patients during each shift.

Procedures may address:

• Recognition of potentially infectious patients
• Respiratory hygiene
• Patient placement
• Employee PPE
• Cleaning and disinfection
• Ventilation
• Respiratory protection when required
• Employee exposure response

Employees should promptly report occupational exposures to communicable diseases according to facility procedures.

Respiratory Protection

When employees are required to use respirators for occupational exposures, the facility should maintain an appropriate Respiratory Protection Program.

The program should address applicable requirements such as:

• Respirator selection
• Medical evaluation
• Fit testing
• Training
• Proper use
• Inspection
• Storage
• Program evaluation

Patient Handling & Ergonomics

Dialysis patients may need assistance transferring between wheelchairs, treatment chairs, scales, and other locations.

Employees should:

• Assess the patient’s mobility.
• Use available patient-handling equipment.
• Obtain assistance when necessary.
• Avoid unnecessary manual lifting.
• Use appropriate transfer techniques.
• Keep equipment positioned to reduce awkward reaching.
• Report ergonomic concerns.

Repeated bending, reaching, standing, and equipment handling should also be considered when evaluating ergonomic hazards.

Slips, Trips & Falls

Dialysis centers may experience water leaks, blood spills, chemical spills, cords, tubing, equipment, and other walking-surface hazards.

Employees should:

• Correct or control spills promptly.
• Maintain clear aisles.
• Manage cords and tubing.
• Keep exits accessible.
• Report damaged flooring.
• Use warning signs or barriers when appropriate.
• Maintain adequate lighting.

Electrical Safety

Dialysis machines, water-treatment equipment, medical devices, computers, refrigerators, and other electrical equipment should be maintained in safe operating condition.

Employees should:

• Report damaged cords, plugs, or equipment.
• Keep inappropriate electrical equipment away from wet conditions.
• Avoid unauthorized repairs.
• Remove unsafe equipment from service.
• Follow applicable electrical safety procedures during maintenance.

Lockout/Tagout & Equipment Maintenance

Maintenance employees may encounter electrical, mechanical, hydraulic, pneumatic, chemical, or stored-energy hazards when servicing dialysis machines, water-treatment systems, pumps, compressors, and facility equipment.

Applicable hazardous-energy control procedures should be followed before servicing equipment when unexpected startup or release of energy could cause injury.

Clinical employees should not attempt maintenance activities beyond their training and authorization.

Oxygen & Compressed Gas Safety

Dialysis facilities may maintain oxygen cylinders or other compressed gases for patient care.

Cylinders should be:

• Properly secured
• Protected from damage
• Stored appropriately
• Kept away from incompatible hazards
• Transported with appropriate equipment
• Protected from unauthorized use

Employees should understand oxygen-enriched fire hazards.

Emergency Patient Events

Dialysis patients can experience acute medical complications during treatment.

Facility procedures should address employee responsibilities for foreseeable events such as:

• Hypotension
• Loss of consciousness
• Excessive bleeding
• Vascular-access complications
• Bloodline separation
• Dialysis machine alarms
• Cardiac emergencies
• Falls
• Allergic reactions
• Other medical emergencies

Employees should know how to summon additional medical or emergency assistance.

Bloodline Separation & Significant Blood Loss

Disconnection or separation of a bloodline or vascular-access component can result in significant blood loss and an occupational blood-exposure hazard.

Employees should be trained to:

• Recognize abnormal conditions promptly.
• Respond to machine alarms.
• Stop or control blood loss according to established procedures.
• Protect themselves from blood exposure.
• Summon assistance.
• Manage contaminated materials.
• Report the event.

Equipment or procedural problems contributing to an incident should be evaluated before treatment operations resume.

Emergency Power & Utility Failure

Dialysis treatment depends on electrical power, water, equipment, and other facility systems.

Emergency planning should address potential interruption of:

• Electrical power
• Water supply
• Water-treatment systems
• Dialysis equipment
• Heating and cooling
• Communications
• Other essential utilities

Employees should understand procedures for safely terminating or managing treatment when essential systems fail.

Fire Prevention & Emergency Action

Employees should understand procedures for emergencies affecting the dialysis facility, including:

• Fire
• Smoke
• Severe weather
• Power failure
• Water failure
• Chemical release
• Medical emergency
• Security threat
• Evacuation
• Shelter-in-place

Emergency planning should account for patients who are connected to dialysis machines or who have limited mobility.

Workplace Violence Prevention

Dialysis employees may develop long-term contact with patients and family members and may encounter individuals who are distressed, frustrated, impaired, or aggressive.

Workplace violence procedures may address:

• Recognizing warning signs
• Reporting threatening behavior
• De-escalation
• Access control
• Panic or alarm systems
• Security assistance
• Working alone
• Law-enforcement notification
• Incident investigation

Employees should know how to obtain assistance when a situation begins to escalate.

Housekeeping & Facility Safety

Dialysis treatment areas, medication areas, clean supply areas, utility rooms, water-treatment areas, storage rooms, offices, and waiting areas should be maintained in a clean and orderly condition.

Clean and contaminated activities should be appropriately separated.

Safety inspections should identify conditions such as:

• Improper storage
• Blocked exits
• Chemical hazards
• Damaged equipment
• Walking-surface hazards
• Electrical hazards
• Inadequate housekeeping
• Improper waste handling

Deficiencies should be corrected in a timely manner.

Employee Exposure Incidents

Employees should immediately report occupational exposures involving:

• Needlesticks
• Sharps injuries
• Blood splashes
• Blood contact with non-intact skin
• Chemical splashes
• Respiratory exposures
• Medication exposures
• Other potentially hazardous incidents

Procedures should provide for prompt evaluation, documentation, medical follow-up, and corrective action as appropriate.

Incident Reporting & Investigation

Employee injuries, exposures, near misses, equipment failures, bloodline incidents, chemical spills, patient-related employee injuries, and other safety events should be reported and investigated.

Investigations should evaluate contributing factors such as:

• Equipment
• Work practices
• Staffing
• Training
• PPE
• Facility layout
• Communication
• Procedures
• Maintenance

Corrective actions should address underlying causes when practical rather than only the immediate event.

Dialysis Center Safety Training

Employee training should reflect assigned duties and occupational exposures.

Training may include:

• Bloodborne pathogens
• Exposure Control Plan
• Vascular-access safety
• Needlestick prevention
• Infection prevention
• Dialysis station practices
• Machine safety
• Cleaning and disinfection
• Blood-spill response
• PPE
• Hazard Communication
• Chemical safety
• Water-treatment safety
• Medical waste
• Respiratory protection
• Patient handling
• Emergency procedures
• Workplace violence prevention
• Incident reporting

Employees should receive additional training when new equipment, chemicals, procedures, or hazards are introduced.

Customized Dialysis Center Safety Manuals

Dialysis facilities vary in size, treatment methods, equipment, water-treatment systems, staffing, medications, and services. Employee exposures can also vary depending on whether the facility provides only in-center hemodialysis or supports additional dialysis-related services.

A customized Dialysis Center Safety Manual can be developed around your facility’s dialysis operations, vascular-access procedures, equipment, chemicals, water-treatment systems, medications, patient-care activities, and employee exposures.