A. A facility shall follow the infection control procedures established in the Control of Communicable Diseases Manual designed by the Centers for Disease Control (CDC) to control the spread of transmissible diseases.
(1) The cardinal measure for preventing the spread of transmissible diseases is an understanding on the part of dialysis and transplantation personnel that each end-stage renal disease patient is potentially a transmitter of transmissible diseases.
(2) Hand Washing.
(a) Dialysis personnel shall practice thorough hand washing, per the Control of Communicable Diseases Manual, between successive contacts with dialysis patients.
(b) Dialysis facilities and transplant centers shall contain adequate hand washing facilities within the patient care area.
(3) Dialysis facilities and transplant centers shall conduct an in-service training session for transmissible disease including hepatitis and the control of hepatitis for newly employed dialysis personnel before the dialysis personnel may participate in patient care, and at least annually for all dialysis personnel.
(4) Dialysis facilities and transplant centers shall establish and enforce written procedures to implement the control of transmissible disease including viral hepatitis as set forth in the Control of Communicable Diseases Manual.
(5) Hepatitis B vaccine is recognized to be effective in producing immunity and is recommended for all staff and patients who are susceptible to hepatitis B virus infection.
(6) Dialysis facilities and transplant centers shall document testing to demonstrate active immunity by appropriate antibody titers.
(7) Hepatitis testing shall be conducted on patients and staff according to the Control of Communicable Diseases Manual.
C. Infection Control and Hygiene.
(1) To the extent possible, the dialysis facility shall physically separate, in time or space, patients who are antigen positive from those who are antigen negative.
(2) Dialysis personnel shall:
(a) Wear personal protective equipment (PPE) at all times while providing patient care;
(b) Be properly bandaged to prevent contact with blood or other bodily fluids, if dialysis personnel have lesions on any body parts;
(c) Wear PPE in activities and situations where contact with blood or other potentially infectious secretions may occur;
(d) Dispose of used gloves immediately upon completion of any procedure and practice thorough hand washing before any other patient contact;
(e) Take necessary precautions to avoid contact with contaminated surfaces and clothing and carefully clean contaminated surfaces with a suitable disinfectant immediately after the patient's dialysis session is ended; and
(f) Remove, dispose of, and replace patient linen and other station coverings immediately after the patient's dialysis session has ended.
(3) A dialysis facility may not permit staff members or visitors to eat, drink, or smoke in the treatment area.
(4) A dialysis facility shall follow the Control of Communicable Diseases Manual recommendations for staff immunization and surveillance for hepatitis B.
(1) Dialysis facilities shall assure that waste and disposable items are packaged or wrapped on the premises of the facility in plastic-lined containers which shall be clearly identified as possibly contaminated materials either by labels or color-coding.
(2) Before including used needles in the specially identified containers described in §D(1) of this regulation, dialysis personnel shall place these needles in separate, rigid containers.
(3) The dialysis facility shall incinerate or make arrangements for the incineration of the dialysis facility's waste in accordance with local, State, or federal regulations.
E. Decontamination. The dialysis facility shall assure that personnel place used linens, scrub clothes, gowns, and laboratory coats in transport bags clearly identified as possibly contaminated material either by labels or color-coding, and that:
(1) Individuals subsequently handling these materials are aware of potential contamination; and
(2) Specimens issuing from dialysis facilities are appropriately treated and identified as possibly contaminated material either by labels or color-coding.