Recently, CCTV exposed the hepatitis C hemodialysis incident in Zhen 'an, Shaanxi Province, which once again exposed the problem of nosocomial infection during hemodialysis treatment. CDC experts point out: hemodialysis patients because of long-term use of fistula treatment access, so the probability of menstrual blood infection is quite high. Therefore, nosocomial infection management in hemodialysis treatment is very important and can not be ignored. It is necessary to seek a set of scientific and effective preventive measures. The problem of hepatitis C infection in hemodialysis patients has become the focus of attention of all hemodialysis workers. How to implement infection control measures such as good hand hygiene, contact isolation, environmental surface cleaning and disinfection, and dialyster management in the process of diagnosis and treatment? The following is to share with you teacher Hu Guoqing's "Do a good job of contact isolation and block the transmission of hemodialysis Hepatitis C", hoping to help you.
According to statistics, the number of new patients accept hemodialysis growing at a speed of more than 11% every year in our country, has far exceeded the growth rate of medical personnel, in 2010, the number of patients relying on dialysis to maintain life will reach 2 million, dialysis patients have low immunity, frequent blood exposure, dialysis involved raw materials, equipment is numerous, pollution link is complex, High requirements for zoning layout, environmental cleaning, disinfection and operator. Without effective disinfection and isolation, infection with viral hepatitis and other menstrual borne diseases is highly likely.
According to the special inspection of hemodialysis rooms in relevant provinces and cities in China, the main problems of disinfection and isolation in hemodialysis rooms are as follows: 1. Wrong disinfection method or inadequate disinfection; 2. 2. Violation of aseptic operation and hand hygiene; 3. Illegal reuse of disposable dialyzers and mixed use of dialyzers by infectious patients; 4. Unqualified environmental hygiene, unreasonable zoning layout and process, etc.
Foreign studies on blocking hemodialysis associated hepatitis C infection:
Italian studies have shown that the rate of hepatitis C infection among dialysers ranged from 25% to 39.4% before any action was taken in dialysis wards, and that the annual rate of hepatitis C infection was reduced to 0.54% after two years of strict disinfection of dialysis equipment.
Studies in Saudi Arabia showed a 23.75% positive rate of HCV in nurses' hand sanitizers after caring for patients with hepatitis C, which can be transmitted if nurses do not observe hand hygiene and perform venipunctures on other patients. Lax disinfection and isolation measures are the root cause of hemodialysis infection!
How to implement contact isolation:
1, equal treatment: all patients' blood, body fluids, secretions, excreta are regarded as infectious.
2, two-way protection:
3. Three kinds of isolation: contact isolation according to the route of transmission, droplet isolation (medical surgical masks are used for droplet isolation), and air isolation (medical protective masks are used for air isolation).
Contact isolation:
(1) Direct contact/indirect contact; Hands/gloves, surfaces of environmental objects, surfaces of medical equipment, medical supplies, work clothes, etc.;
(2) Applicable objects: intestinal infection, multi-drug resistant bacterial infection, skin infection, etc.;
(3) Isolation measures: ① isolation ward; ② Hand hygiene and gloves; ③ isolation clothes; (4) Limit the patient's range of motion; ⑤ Disinfection and terminal disinfection at any time.
Eight specific measures to implement standard prevention:
1. Hand hygiene;
2. Wear gloves;
3. Proper use of masks, goggles and masks;
4. Wear isolation clothing, protective clothing and shoe covers when appropriate;
5. Disposal of contaminated medical equipment or articles;
6. When resuscitation is possible in the first aid place, simple breathing sac (resuscitation bag) or other ventilation devices should be used instead of mouth-to-mouth artificial respiration;
7. Medical waste shall be treated harmlessly in accordance with the Regulations on Medical Waste Management and relevant laws and regulations.
8. Disinfection of environment, object surfaces, clothing and dining utensils.
Separate nursing staff, medical supplies and treatment vehicles:
1, nursing staff should be relatively fixed, nursing staff caring for hepatitis B and hepatitis C patients should not care for hepatitis B and hepatitis C negative patients at the same time. Staff perform standard prevention techniques.
2. Equipment and articles used by infected patients, such as medical records, sphygmomanometer, stethoscope, treatment car, dialysis machine, etc., should be marked.
3. It is recommended that HIV-positive patients go to designated hospitals for dialysis or peritoneal dialysis.
4. Pay attention to the disinfection of the treatment car after use.
5. Focus on sharing heparin.
