Guideline for Applied Hygiene in Dialysis Units

1;Table of Content;6
2;Preface to the 2nd Edition;12
3;Additional preface to the translated 2nd Edition 2008 in English;14
4;1 Introduction;16
4.1;16;17
4.2;1.1 Goals, Structure and Working Method of the Working Group;17
4.3;17;18
4.4;18;19
4.5;1.2 Purpose;19
4.6;1.3 Usage and Assessment;19
4.7;19;20
4.8;20;21
4.9;21;22
4.10;1.4 Quality and Hygiene;22
4.11;22;23
4.12;23;24
4.13;24;25
4.14;25;26
4.15;26;27
5;2 Legal Basis;27
5.1;2.1 Definition of Responsibilities;27
5.2;2.2 Responsible Organisation;28
5.3;2.3 Equality of Occupational Health and Patient Safety;28
5.4;2.4 Biological Agents Ordinance ( BioStoffV);29
5.5;2.5 The Hygiene Plan;32
6;3 Structural Requirements;37
6.1;3.1 Goal and Rationale;37
6.2;3.2 Space Required;37
6.3;3.3 Room Set-up and Installations;41
6.4;3.4 Sanitary Facilities;41
6.5;3.5 Requirements on the Indoor Air;42
6.6;3.6 Sewage System;42
7;4 Medical and Technological Requirements in Haemodialysis;44
7.1;4.1 Goal and Rationale;44
7.2;4.2 Water Purification;44
7.3;4.3 Dialysis Machines;47
8;5 Staff requirements;52
8.1;5.1 Goal and Rationale;52
8.2;5.2 Staffing Structure;52
8.3;5.3 Initial and Annual Instruction;53
9;6 Requirements for the Organisation;56
9.1;6.1 Goal and Rationale;56
9.2;6.2 General Hygiene;56
9.3;6.3 Water and Solutions for Haemodialysis Procedures;79
9.4;6.4 Monitoring and Evaluation of Permeate and Dialysis Fluids;81
9.5;6.5 Disinfection Measures for the Fluid Pathway and the Dialysis Machines;86
10;7 Particular Aspects of Hygiene in Dialysis Treatment;92
10.1;7.1 Vascular access;92
10.2;7.2 Home Dialysis Treatment;103
10.3;7.3 Special Epidemiological Aspects;109
11;8 Catering;145
11.1;8.1 Goal and Rationale;145
11.2;8.2 Hygienic Requirements for the Supply of Food to Patients;145
11.3;8.3 Requirements on Staff;146
11.4;8.4 Requirements on Staff Hygiene;148
11.5;8.5 Hygienic Requirements regarding Structural and Organisational Conditions;149
11.6;8.6 Hygienic Requirements for Handling Foodstuffs;151
12;9 Waste Management;154
12.1;9.1 Goal and Rationale;154
12.2;9.2 Legal Basis and Recommendations for Waste Management;154
12.3;9.3 Type and Origin of Wastes;154
12.4;9.4 Classification of Waste Types;156
13;10 Examination of the Effectiveness of Disinfection Procedures for Dialysis Machines;160
14;11 Check Lists and Forms;161
14.1;11.1 Home Haemodialysis;161
14.2;11.2 Peritoneal Dialysis Preconditions and Operation;163
14.3; 11.3 Quality Requirements for Drinking Water and Permeate;165
14.4;11.4 Letter to Communal Water Suppliers;167
14.5;11.5 Return of Dialysis Machines from Patients with Blood- Transmissible Viral Infections;168
14.6;11.6 HBV Diagnostics;169
14.7;11.7 HCV Diagnostics;171
14.8;11.8 Post Exposure Prophylaxis ( PEP) for Staff;172
14.9;11.9 Indication for the Initiation of Pharma-cotherapy as Post Exposure Prophylaxis ( PEP) in Case of Exposure to HIV;173
14.10;11.10 HBV Post Exposure Prophylaxis ( PEP) for Staff after Presumable Contact with HBV- Containing Material;173
14.11;11.11 HCV Post Exposure Prophylaxis ( PEP) for Staff;174
14.12;11.12 Hygiene Measures during Infectious Illnesses;175
14.13;11.13 Information Sheet for MRSA Patients;178
14.14;11.14 MRSA Infection Plan for procedure EXAMPLE142;181
14.15;11.15 Template for Catering;183
15;12 Abbreviations;186