Infection Control Management in Dialysis Units: The Importance of Water Quality and Device Disinfection
Dialysis treatment is a life-sustaining practice for patients with chronic kidney failure. However, this treatment process is one of the most sensitive areas in terms of infection risk, as it requires direct access to the bloodstream.
Therefore, infection control management in dialysis units is of critical importance not only for the safety of patients but also for healthcare workers.
In this article, we will discuss in detail how dialysis infection control, water quality and device disinfection processes should be managed in light of national and international standards.
Sources of Infection Risk in Dialysis Units
During dialysis, there is multiple contact between blood, water, and device systems. Therefore, infections can arise from various sources:
- Water system contamination
- Inadequate disinfection of dialysis device internal lines
- Vascular access site infections
- Poor hand hygiene
- Environmental surface contamination
To reduce these risks, each factor must be controlled and regular monitoring processes must be established.
Water Quality: The Cornerstone of Dialysis Safety
1. The Importance of Water Treatment Systems
The water used in dialysis indirectly enters the patient’s circulatory system. Therefore, the microbiological and chemical quality of the water directly affects treatment safety.
- AAMI (Association for the Advancement of Medical Instrumentation) and
- the Ministry of Health Dialysis Centres Regulation
have established reference values for water quality.
2. Parameters to be monitored in water quality
The critical parameters for dialysis water are as follows:
- Total bacterial count: <100 CFU/mL
- Endotoxin level: <0.25 EU/mL
- Conductivity, pH, chloramine, hardness, and heavy metal levels
Water quality should be regularly monitored through weekly microbiological analyses and monthly chemical analyses.
3. Biofilm Risk
Biofilm formation may occur in water systems over time. This layer leads to bacteria developing resistance.
For biofilm control:
- Periodic chemical disinfection,
- Hot water or chemical cleaning cycles
- Filter change monitoring
should be carried out systematically.
Dialysis Machine Disinfection: An Effective and Safe Approach
- Disinfection Frequency and Procedures
Dialysis machines should be disinfected after each patient and at the end of the day, in accordance with the manufacturer’s instructions. The disinfectant used should not allow biofilm or pyrogen formation on the internal surfaces of the machine. - Appropriate Disinfectant Selection
Chemicals used for device disinfection should have the following properties:
- Be based on citric acid, malic acid, or peracetic acid,
- Demonstrate sporicidal activity,
- Have a short contact time,
- Be compatible with materials and leave no residue.
Products meeting these criteria should be preferred for the effective and safe disinfection of haemodialysis devices. Detro Hemoplus PAA, which possesses these characteristics, can be safely used for the routine disinfection of haemodialysis devices.
Staff Hygiene and Training
No technical infrastructure can provide adequate protection without staff compliance.
Therefore, in dialysis centres:
- Hand hygiene practices should be regularly monitored,
- The use of personal protective equipment (PPE) should be mandatory,
- Training and awareness programmes should be conducted periodically.
Additionally, it is important that the antiseptics used are highly skin-compatible, non-allergenic, and suitable for long-term use.
For example, povidone-iodine-based antiseptic soaps (Detro PW 7.5% Scrub) can be safely used in hand hygiene standardisation.
Infection Control Committee and Monitoring Process
Infection control in dialysis centres should be supported not only by implementation but also by a continuous monitoring and reporting system.
In this context:
- Monthly microbiological monitoring reports,
- Water quality analysis results,
- Disinfection log records
- Patient-based infection rate (per 1,000 catheter days)
should be evaluated regularly.
Continuous Improvement Approach
The PDCA (Plan – Do – Check – Act) cycle forms the basis of dialysis infection control management.
In this process:
- Risks are identified,
- Preventive measures are implemented,
- Results are monitored,
- New standards are established.
This approach ensures full compliance with the Ministry of Health’s quality standards and the ISO 9001 and ISO 13485 systems.
Frequently Asked Questions (FAQ)
1. How frequently should water quality tests be conducted in the dialysis unit?
Microbiological analyses should be performed weekly, and chemical analyses monthly. Additionally, samples must be taken again after system maintenance.
2. How should disinfection records be maintained?
All procedures must be recorded using digital or written log forms, including the date, product, concentration, and responsible personnel information.
3. Which antiseptics are recommended for staff hand hygiene?
Chlorhexidine gluconate, povidone-iodine, or alcohol-based products are the first choices recommended in international guidelines.
- Chlorhexidine-based products: Detro Hexidin Plus
- Alcohol-based products: Detro Derm, Detro Derm Soft 72%, Detro Derm Soft Gel
- Povidone-iodine-based products: Detro PW 10%, Detro PW 7.5%
These products have been developed in appropriate concentrations and formulations for hand hygiene and can be safely used in dialysis centres.
Infection control management in dialysis units is not limited to device disinfection or hand hygiene.
When water quality, cleaning of device internal lines, surface hygiene and staff training are addressed together, patient safety and service quality are maximised.
It should be remembered that preventing dialysis infections is much easier than treating them.
