Haemodialysis – acute care delivered in a non-acute setting. Constant risk evaluation and management is the key

Carolyn Chenoweth1

1Fresenius Medical Care, Payneham Dialysis Clinic, 2 Portrush Road, Payneham SA 5070. carolyn.chenoweth@fmc-asia.com

 

Haemodialysis is full of contradictions: acute care delivered in a non-acute setting; long term patients in a day procedure centre; isolation treatments for patients who share waiting rooms and transport with others; patients with respiratory illnesses and multi-resistant organisms receiving treatment in the same area as immunosuppressed patients.

Infection prevention and control (IPC) does not sit neatly in a well-defined box. Each patient is an individual with different IPC, social and physical needs. If every patient was treated in a single room, with a dedicated dialysis machine and their own nurse, there would be no problems from an IPC perspective. However we are social people living in a world with finite resources.

The IPC challenges that dialysis nurses face each shift is how to manage multiple patients with unique and complex needs while working within national, state/territory, local and company IPC guidelines.

General IPC guidelines don’t always meet specific haemodialysis patient needs so nurses need to decide each shift which IPC guidelines will be the most effective in delivering care with the least risk of transmission of infections to other patients and staff. These decisions are supported by constant risk identification, evaluation and management.

Haemodialysis IPC guidelines are reviewed in a risk management framework and their practical impact on delivering haemodialysis treatments in non-acute settings.