Aseptic technique

In reading previous posts most home patients say they do not wear gloves. How about if you have a partner who is putting you on the tx- does that person need to wear gloves and other protective gear?

We were given a manual to read for one of the home machines. It states to use strict aseptic technique using gloves, gown and goggles, but does not go into what aseptic technique is and the rationale behind it. What did your nurse trainers tell you do to in this respect?

The use of gloves, face shields and barrier garments are meant to protect staff in dialysis clinics from becoming infected with any blood borne germs that a patient may have and transferring that infection to others. People on dialysis (just like people in the general public) can have undiagnosed infections that could infect staff and other patients. The use of antibacterials to clean the skin and use of gloves when inserting dialysis needles or connecting lines to catheters are intended to prevent germs from the surface of the patient’s or staff member’s skin from being introduced into the patient’s blood stream. Here are the K/DOQI guidelines on preventing infection that describe aseptic technique without actually calling it that:

Patients doing self-cannulation may or may not use gloves if they’ve cleaned their hands and their access site as directed by their nurse and if their clinic doesn’t require gloves. A dialysis partner needs to use gloves to not only protect himself/herself from germs in the patient’s blood, but to protect the patient from germs that the dialysis partner may have on his/her skin.

I have never heard of a home partner using a face shield or barrier garment in the home setting. However, some may do this. I suspect blood spills that warrant these occur protections much less at home where attention is focused on one person at put-on and take-off where in a clinic there are numerous distractions and multiple patients to care for that could alter focus temporarily leading to a blood spill.

I’ll be anxious to read what others write, but in my opinion, in the home setting where one person (patient or partner) is taking care of one patient, the dialysis partner is less likely to become infected with unknown germs because the patient’s blood has been tested for common infections and been given shots to provide immunity to Hepatitis B. Any symptoms of infection should be reported and treated promptly.

Gloves are not sterile. I see the use of gloves as a way to limit the spread of pathogens among people because if they get soiled you can just remove them, rather then touch a sink with bloody hands to wash. If you are making a sterile connection - a needle line to the machine for instance - and an open line end brushed a glove that line is contaminated and should wiped with alcohol. If the line brushes well cleaned, bare skin it is not necessarily contaminated though the line should be wiped.

It is easy to accidentally brush a hand with an open line when connecting but that accident is harder to detect through gloves.

For self dialyzors I think one is safer without gloves, just clean both hands carefully. And respond to accidental open line touching.

What if a patient line drops on the floor-should it be wiped with alcohol or discarded?

In my opinion, I’d throw it away because I wouldn’t want to risk sepsis. I’ll be interested to hear what others who actually do dialysis say about what they were trained to do.