Washing Your Access

The Importance of Washing Your Access
        
by Lynda K. Ball, MSN, RN, CNN

You have probably been asked to wash your access just before going to your dialysis chair. And, I know that some of you have questioned the nurse or technician about the need for washing your access – you took a shower before you came to dialysis or they imply that you have poor hygiene. Actually, there are several important reasons why you should wash your arm right before sitting down.

First, your immune system does not protect you from infection like it did when you did not have kidney disease and your doctor may have told you that you are now immunosuppressed. What this means is that you are at increased risk of developing an infection. Vascular access infection is the most common infection in hemodialysis patients and is the second most common cause of death (15%), according to the Centers for Disease Control and Prevention (CDC). 1 The biggest risk factor is the type of vascular access you have – catheters have the highest infection rate, followed by grafts, and AV fistulas have the lowest infection rate. So, prevention of infection is the key and it is important that you can recognize the symptoms of infection: unexplained pain, chills, fever, drainage, and redness or swelling.

Second, all of us have bacteria on our skin that helps to protect us from other kinds of germs. The name of this bacteria is Staphylococcus aureus, but the nurses and technicians may use the shortened name - staph. Some people also have staph in their noses and can spread bacteria simply by breathing. Did you know that dialysis patients have more staph on their skin and in their noses than the general population? Several studies have confirmed this, and it is the major reason that nurses and technicians ask you to wash your arm before dialysis – to reduce the number of bacteria on your skin. 2 Simply stated, my staph protects me and your staph protects you, but your sterile bloodstream does not like staph either from you or anyone else, and a severe infection could result. That is why patient care staff wear gloves during cannulation.

Third, antibiotic resistance has been rising sharply over the last decade. Antibiotic resistance occurs from people taking antibiotics frequently, not taking the entire prescription, or taking them when they were not needed. The bacteria learn to change their DNA or mutate so the antibiotic cannot kill the bacteria, and this forces the doctor to find another antibiotic to try and cure the infection. Because dialysis patients are at high risk for antimicrobial resistant infections, the CDC has developed a fact sheet called “Tips for Dialysis Patients to Prevent Antibiotic Resistance.” This fact sheet is available on the CDC website, or if you do not have access to the internet, ask your dialysis facility to print you a copy. One of the tips says to “follow the unit policy on cleaning instructions for your access carefully before every cannulation.”

In closing, because we care about you, we ask you to wash your access just before coming to your chair in order to protect you from infection. By reducing the number of bacteria on your access, there is less risk of bacteria getting into your sterile bloodstream. This will keep you out of the hospital and allowing you to do the things in life you enjoy.

1. CDC. Recommendations for Preventing Transmission of Infections Among Chronic Hemodialysis Patients. MMWR 2001; 50(5): 13. 2. Kaplowitz, L.G. Comstock, J.A., Landwehr, D. M., Dalton, H.P. and Mayhall, C.G. (1988). Prospective study of microbial colonization of the nose and skin and infection of the vascular access site in hemodialysis patients. Journal of Clinical Microbiology. 26(7):1257-1262. 3. Centers for Disease and Prevention. CDC campaign to prevent antimicrobial resistance in healthcare settings, tips for dialysis patients to prevent antibiotic resistance. Retrieved 7/18/05 from the website http://www.cdc.gov/drugresistance/healthcare/dialysis/Tips_for_Dialysis_Patients.pdf.

For more information contact Northwest Renal Network at 206.923.0714 x 111.

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Page updated February 18, 2015