Infection Control Measures for Peritoneal Dialysis
For patients undergoing peritoneal dialysis, strict adherence to personal protective equipment protocols, proper effluent decontamination with 2% sodium hypochlorite solution, and daily topical antibiotic prophylaxis to the catheter exit site are essential to prevent life-threatening infections.
Personal Protective Equipment (PPE) Requirements
All healthcare workers performing peritoneal dialysis exchanges must wear comprehensive protective gear including waterproof disposable gowns, caps, gloves, face shields, and N95 face masks 1. This full protective equipment protocol was established during the SARS outbreak and remains the standard for high-risk dialysis settings 1. The patient should also wear a surgical mask during all dialysis procedures to reduce respiratory droplet contamination 2, 3.
Hand Hygiene and Aseptic Technique
- Enhanced hand hygiene by both patients and healthcare workers is mandatory before and after every patient contact and dialysis exchange 1, 2.
- Strict aseptic technique must be maintained when connecting the access to the dialysis system 1.
- Hand hygiene protocols should be performed even when gloves are worn, as gloves do not eliminate the need for proper handwashing 1.
Effluent Decontamination
All spent peritoneal dialysis effluent must be decontaminated with 2% sodium hypochlorite solution before disposal 1. This critical step prevents environmental contamination and cross-transmission within the dialysis unit 1. The decontamination protocol applies to all dialysate waste, regardless of whether the patient has a known infectious disease 1.
Exit Site Care and Antibiotic Prophylaxis
Daily topical application of mupirocin antibiotic cream to the catheter exit site significantly reduces infection risk and should be standard practice 4, 5. Mupirocin treatment can reduce the risk of exit site infection by 46% 4. This prophylactic measure is particularly important for preventing Staphylococcus aureus infections, which are among the most common causative organisms in peritoneal dialysis-associated infections 4, 6.
- Exit site care protocols must include proper disinfection with alcoholic chlorhexidine (>0.5%), alcohol, or tincture of iodine 7.
- Treatment for S. aureus nasal carriage should be implemented as part of comprehensive infection prevention 4, 6.
Environmental and Equipment Infection Control
Environmental surface cleaning with appropriate disinfectants on all equipment, dialysis chairs, and surfaces the patient contacts is essential 2. Contaminated water, equipment, and environmental surfaces can serve as sources of infection in dialysis settings 1.
- Dedicated equipment should be used for peritoneal dialysis patients when possible 1.
- All potentially contaminated materials, including unspent dialysate concentrate, must be discarded as infectious waste 1.
Patient Training and Monitoring
Adequate patient training with periodic retraining is crucial to decrease infection risk 6. Continuous quality improvement programs with ongoing monitoring of both exit site infections and peritonitis episodes should be routine in peritoneal dialysis programs 6.
- Home visits by trained peritoneal dialysis nurses improve infection prevention outcomes 8.
- Every episode of infection should undergo root cause analysis to identify preventable factors 6.
Prophylactic Antibiotics for Procedures
Prophylactic antibiotics must be administered before catheter placement, colonoscopy, or invasive gynecologic procedures 5. This prevents procedure-related peritonitis, which is a preventable complication 6, 5.
- Antifungal prophylaxis, preferably oral nystatin, should be added whenever patients receive antibiotic treatment courses to prevent secondary fungal peritonitis 8, 5.
Critical Pitfalls to Avoid
Never neglect effluent decontamination, as this creates a major source of cross-contamination within dialysis units 1. The disposal of spent dialysate poses significant infection control challenges that distinguish peritoneal dialysis from other patient care activities 1.
- Avoid inadequate PPE use, as the proximity of patients to each other and care by the same healthcare workers creates high transmission risk 1.
- Do not skip S. aureus screening and prophylaxis, as gram-positive cocci are the most frequent causative agents of peritoneal dialysis-associated peritonitis worldwide 4.
- Never delay catheter removal for fungal peritonitis—immediate removal plus antifungal treatment for minimum 3 weeks is standard practice 4.
ICU-Specific Considerations
In the intensive care unit setting, peritoneal dialysis exchanges should be performed at the bedside by ward staff wearing full protective gear 1. Intermittent peritoneal dialysis is preferred during hospital stays for critically ill patients 1.