The

Peritoneal Dialysis Quality Standards

Ministry of Health Malaysia
2019
This document was developed by the Malaysian Society of Nephrology in collaboration with the Medical Services Unit,
Medical Division, Ministry of Health Malaysia amd the Drafting Committee for Peritoneal Dialysis Quality and Standards.

Published August 2019

A catalogue of this document is avaiolable from the library and Resource Unit of the Institute of Medical Research,
Ministry of Health;

MOH/……

And also available from the National Library of Malaysia

ISBN…………

All rights reserved. No part of this publication may be reproduced or distributed in any form or by any means or stored in
a database or retrieval system without prior written permission from Malaysian Society of Nephrology and the Director of
the Medical Development Division, Ministry of Health Malaysia.
CONTENTS

Page

Foreword
List of Contributors
Acknowledgements

1 Objectives & Scope

2 Physical Facilities
2.1 Introduction
2.2 PD Exchange Area
2.3 Treatment/Consultation Area
2.4 Effluent Disposal System

3 Equipment

4 Dialysis Consumables

5 Water Quality

6 Human Resource
6.1 Introduction
6.2 Person-in-charger (PIC)
6.3 Nephrologist
6.4 Registered Nurse/Medical Assistant

7 Monitoring of Dialysis Patients

7.1 Monitoring of New PD patients
7.2 Records of Dialysis Treatment
7.3 Long term monitoring of dialysis patients

8 Infection Control Measures

8.1 Introduction
8.2 Measures to Prevent Transmission of Infection
8.3 Prevention and Control of Hepatitis B Infection
8.4 Prevention and Control of Hepatitis C Infection
8.5 Prevention and Control of HIV Infection
8.6 Screening and Vaccination of Staff

9 Outcome Measures and Quality Initiatives in Dialysis

9.1 Reporting to Nnational Renal Registry
9.2 Peritonitis Episodes
9.3 Dialysis Adequacy
9.4 Incident Reporting to Ministry of Health

10 Dialysis Disaster Quality Management

10.1 Mitigation Phase
10.2 Preparedness Phase
10.3 Response
10.4 Recovery Phase

11 Home Visits

12 PD Satellite Units

13 Appendices
Appendix 1: PD Standard Operating Procedures

Appendix 2: RRT CPG on management of peritonitis

Appendix 3: Laboratory investigations schedule for chronic haemodialysis patients

12 References

13 Glossary of Terms and Definitions

Foreword By The Director General of Health Malaysia

Peritoneal Dialysis (PD) was first introduced in Malaysia in the 1960’s and PD growth has
slowly but steadily increased but steadily. Over the past 20 years, PD penetration has
contributed only 10% of the overall renal replacement therapy for end stage kidney
disease (ESKD) compared to haemodialysis in Malaysia but growth has occurred within
the public sector . This such that the penetration here is now 30% PD growth occurs
mainly in the public sector.

Currently, continuous effort has been made for passionate nephrologists to increase PD
uptake in the country not only in public sector but also in non-governmental organisation s
(NGO) and the private sectors. Health economic studies have shown that PD has more
economic value than haemodialysis in developing countries like Malaysia.

This is the first national PD quality standards document that has been prepared to provide
recommendations for a PD unit to fulfil and adhere to. This document will also serve as
guidance for enforcement units such as CKAPS/UKAPS (Cawangan/Unit Kawalan Amalan
Perubatan Swasta) to ensure acceptable treatment is provided for PD patients. It is
important that the recommendations are appropriate for the local setting from both quality
standards and economic perspective.

I hope that in years to come, peritoneal dialysis will not only become more attractive for
patients to choose as their dialysis modality but alsoalso to be taken up by NGOs and the
private sector. It is my sincere hope that this document will play an important role and
contribute better quality of care for PD patients in this country.

Datuk Dr Noor Hisham bin Abdullah

Foreword By the Head of National Nephrology Services

Peritoneal dialysis (PD) is an important modality for the treatment of end stage renal
disease. Clinical advantages of PD over haemodialysis includes better preservation of
renal function, and better anaemia management. As PD is a home-based therapy infra-
structure and staff requirements are less. It is useful for patients living in remote area and
those with difficulty in travelling to dialysis centres and it is more cost effectiveness than
building multiple small haemodialysis centres.

Since the introduction of peritoneal dialysis (PD) almost a century ago, PD technology
there have considerable improvements in the design of the PD catheter and the PD
system including the connectology and the PD solutions. Nevertheless, problems with PD
persists including peritonitis and high technique failure rate.

It is therefore important that PD units maintain a high standard to improve the performance
and outcome of patients on PD. The development of these national need for standards for
PD care is timely as Ministry of Health strives to increase the penetration of PD services
in the country.

I would like to express my gratitude to the team for their hard work in developing this
standard.
Dato Dr Ong Loke Meng

LIST OF CONTRIBUTORS

Dr Lily Mushahar
Consultant Nephrologist
Hospital Tuanku Ja’afar Seremban
Negeri Sembilan

Professor Dr. Goh Bak Leong

Senior Consultant Nephrologist
Serdang Hospital, Selangor

Dr. Sunita Bavanandan

Consultant Nephrologist
Kuala Lumpur Hospital

Dr Shahnaz Shah Firdaus Khan

Consultant Nephrologist
Hospital Tunku Ampuan Rahimah
Klang

Mahani Ahmad
Head PD Nurse
Hospital Tuanku Ja’afar Seremban
Negeri Sembilan

Noriah Othman
Head PD Nurse
Hospital Tuanku Ampuan Rahimah
Klang Selangor

Nor Juliana Md Yunus

Senior PD Nurse
Hospital Tuanku Ja’afar Seremban
Negeri Sembilan

Jamaiyah Supar
Senior PD Nurse
Hospital Kuala Lumpur

ACKNOWLEDGEMENTS
Acknowledgement for the contribution and participation in the preparation of this document:
Dr.Adibah Hani Haron
Senior Principal Assistant Director
Medical Development Division
Ministry of Health Malaysia

CHAPTER 1: OBJECTIVES & SCOPE

1.1. Objectives
The purpose of this standard document is to define the requirements for peritoneal
dialysis (PD) units to achieve the acceptable minimum level of quality, performance,
safety and reliability of services provided.

1.2. Scope
The standard covers essential aspects of PD treatment including physical facilities,
equipment, consumables, human resource, training & monitoring of dialysis
patients, infection control measures, quality measures, home visits and disaster
management for PD.

CHAPTER 2: PHYSICAL FACILITIES

2.1 Introduction
The PD unit should be in an enclosed and clean area. There shall be adequate
space and facilities for all PD activities to be performed in the PD units and for the
required volume of work. This includes:
 i) Compulsory area for:
 PD exchange
 Treatment/procedure
 Effluent disposal
 Nurses counter

ii) Access to:

 Safe Record-keeping area
 Storage area/room
 Clinical waste / sluice room
 Toilet
 Janitor Room

2.2 PD Exchange Area

2.2.1 There shall be adequate space for PD exchange for each patient, 4.5m2 per patient
2.2.2 Each PD exchange area should have a table, chair and drip stand
2.2.4 Adequate wash basins with elbow-tap should be provided for maintenance of good
hand hygiene

2.3 Treatment/Consultation Area

2.3.1 There shall be facilities and equipment for the treatment and care of PD patients
commensurate with the clinical procedures conducted within PD facilities for
example exit site care, change of transfer set, PET and KTV testing
2.3.3 An area to accommodate a couch is required for examination and treatment, with a
minimum area of 6.0m2

2.4 Effluent disposal system

The PD effluent should preferably drain into the sewerage system. If drained into a
septic tank, the tank size shall be of adequate capacity to handle the volume of
effluent

CHAPTER 3: EQUIPMENT

 PD cycler
 Hanging scale
 Weighing Scale: Standing and Sitting
 Drip stand
  Oxygen supply
 Dressing Trolley
 Emergency Cart (Trolley) with defibrillator
 Non-invasive Blood Pressure Monitoring (NIBP) set
 Volumetric Infusion pump
 Electrocardiograph (ECG) machine
 Glucometer
 Refrigerator
 Thermometer
 PD exchange chair* ( why asterisked? There is no footnote? )
 PD exchange table*
 Wheelchair
 Fridge
 Storage Cabinet for consumables and record keeping
 Couch
 Bins for clinical waste, sharp and general waste
 Computer with Internet connectivity

CHAPTER 4: PD CONSUMABLES
 Mask
 Disposable sterile glove
 Dressing set
 PD catheter clamp
 Transfer set
 Titanium connector
 Sterile gauze & cotton
 On & off tray- for transfer set exchange
 Hand rub
 Povidone Iodine
 Copper sulphate
 Alcohol 70% solution
 Alcohol Swab
  Water for injection
 Heparin
 Gentamicin and/or Mupirocin cream
 Syringes (1, 3, 5,10 and 20cc)
 Needle (19, 21 and 23G size)
 Venofix (21 and 23G size)
 Plaster (1cm & 5cm width size)
 IV Drip Tubing
 Surgical blade size 11
 Specimen bottle for blood
 Specimen bottle for PD fluid
 Culture bottles
 Spillage kit

CHAPTER 5: PD TRAINING
• Patients can be trained in the PD centre, PD satellite unit or in their own homes
• The PD trainer must be a qualified PD nurse (see Human resources section)

CHAPTER 6: HUMAN RESOURCE

6.1 Introduction

This section defines the pre-requisite qualifications and responsibilities of the key
personnel of a PD unit

6.2 Person-in-charge (PIC)

6.2.1 Definition

The person-in-charge (PIC) as defined in the Private Healthcare Facilities And

Services Act 1998 means a person possessing such qualification, training and
experience as may be prescribed and who shall be responsible for the management
and control of the private healthcare facility or service to which a licence or
 registration relates. The PIC is the person held legally responsible in the Act to
manage, control, maintain and operate the PD unit and punitive measures may be
taken against the PIC who violates the Act.

6.2.2 Qualification

• The PIC of a PD unit shall be a nephrologist

6.2.3 Responsibilities

Responsibilities of the PIC shall include (but not limited to):

• ensuring proper functioning and maintenance of the facility and equipment
• ensuring that the centre complies to the norms and standards required
• ensuring that each patient has a nephrologist to assume all medical care of
the patient
• ensuring that there is a standing arrangement with other medical
practitioners to provide immediate medical care, essential life-saving
measures and emergency procedures on any person requiring such
treatment or services in the event that the PIC is not available
• ensuring the safety of patients and staff of the PD unit
• periodic review of policies and procedures
• performing quality assurance activities including submission of data to
National Renal Registry

6.3 Nephrologist

6.3.1 Definition

A nephrologist is a physician who has completed a recognised post-graduate

training in nephrology in an accredited centre and is registered with the National
Specialist Register

6.3.2 Qualifications

A nephrologist shall be registered and comply with the conditions stipulated in the
National Specialist Register

6.3.3 Responsibilities

Responsibilities of the nephrologist shall include (but not limited to):

• advice on the facilities, equipment and staffing requirements of the PD unit
• advice on policies and standards for PD treatment in conformity with the
requirements of the regulations and/or any nationally accepted guidelines
• plan clinical management of the dialysis patients
• prescribing PD treatments. All PD treatment shall be prescribed by a
 nephrologist.
• review each individual patient at least once in every three months. Such
review shall be comprehensive and shall include but is not limited to clinical
examination, review of blood and other test results and medications
• recommend changes or modifications to treatment as deemed necessary
from time to time in order to maintain the quality of care

6.4 Registered Nurse/Medical Assistant

6.4.1 Qualifications
• Shall be credentialed by the National Credentialing Committee i.e:
i) Have a recognised post basic renal certificate/ advanced
diploma/equivalent and
ii) Have at least six (6) weeks training and six (6) months working
experience in an accredited PD unit under the supervision of a
registered nephrologists prior to performing PD treatment
• Those without post-basic certificate have to be privileged and work
under the supervision of an accredited PD nurse.
i) Requirement for privileging is minimum of six (6) weeks training
and six (6) months working experience with a completed log
book in an accredited PD unit under the supervision of a
registered nephrologist prior to performing PD treatment. The
validity of the credentialing is for 3 -years after certification and
credentialing needs to be renewed.

ii) Proficiency of staff performance for required skills must be

assessed based on observation by an assessor. The assessor
shall be a holder of a recognized Renal Post Basic nursing
certificate or equivalent from an accredited institution and have at
least 2 years of working experience in the PD unit, or
Credentialed Nephrologist with PD experience at least 2 years.
The assessor shall be either:
a. Nephrologist or
b. PD manager
 A nurse working in an accredited PD facility shall have to complete a log
book within 6 months that must be endorsed by Sister in charge of the PD
unit with post basic certification in renal nursing and with 5 years ( I agree
with prof Goh) of working experience or Head of Department/Consultant
Nephrologist in charge of PD unit

6.4.2 Responsibilities

Responsibilities of the trained registered nurse/medical assistant shall include (but

not limited to):
• performing PD training
 • performing PD exchanges, PD adequacy test, peritoneal equilibrium
test(PET)
• monitoring of PD patients
• administration of antibiotics for PD related infections
• supervision of other PD staff
• care of dialysis equipment and systems
• education and training of PD patients and their families

6.4.3 PD Manager

It is desirable for the PD unit to have a PD manager. PD manager shall have at

least 2 years working experience in a PD centre and beis certified in renal nursing

6.4.4 Staff-to-patient ratio

i) An adequate number of staff is required in the facilities to ensure care and
treatments are performed safely and effectively
ii) For every twenty-five (25) PD patients, there shall be at least one registered
nurse/ medical assistant with at least six months training in PD treatment and
care in each shift (1 nurse: 25 patients)
iii) For satellite PD units: the ratio is 1 nurse: 35 patients

6.4.5 Operational definition

1. An aAccredited training PD centre shall:

a. Have a fulltime Nephrologist cover
b. Have minimum of 2(two) PD nurses with recognized Renal Post
Basic*/equivalent certificate from an accredited college and minimum of 3
years experience in PD ( same thing here- prob 2 years enough?)
c. Have at least 100 PD patients
d. Have PD access surgery services
e. Have an accredited lab able to perform standard tests
f. Be involved in a Continuous Quality Improvement (CQI) program
g. Be compliant to the National PD Quality Standards
h. Meet the requirements under Private Care Facility Act and be licensed (for
Private and NGO centre)

2. Accredited college
a. College with Malaysian Qualification Agency (MQA) Certification

* Recognised by Lembaga Jururawat Malaysia

CHAPTER 7: MONITORING OF DIALYSIS PATIENTS

7.1 Monitoring of new PD patients
On completion of PD training, the patient should be reviewed at 2 weeks and 1
month. The PD treatment shall be monitored closely, with particular attention to:
• PD technical problems e.g. leaking, exit site infections
• Vital signs: blood pressure, pulse and temperature electrolytes
• Ultrafiltration and target dry weight assessment

7.2 Records of dialysis treatments

Each dialysis treatment shall be recorded in the patient PD treatment record book
or an electronic record

7.3 Long-term monitoring of dialysis patients

Patients should be monitored at least every 1-3 months

7.3.1 Blood Investigations

Blood investigations shall be performed at regular intervals or more frequently if
necessary. The minimum frequency is listed in Appendix 4

7.3.2 Dialysis Adequacy

• Dialysis adequacy shall be monitored at least every six (6) monthly. This can be
calculated using Kt/V or Urea Reduction Ratio (URR)
• The target delivered Kt/V shall be more or equal than 1.7

CHAPTER 8: INFECTION CONTROL MEASURES

8.1 Introduction

8.1.1 All PD units shall have stringent measures to minimise the risk of cross-infection
amongst PD patients

8.2 Measures to prevent transmission of infection

8.2.1 Infection Control Precautions for all patients

Staff working in PD unit shall ensure implementation and adherence to strict
infection control procedures designed to prevent cross-infection. Refer to Appendix
5 for suggested infection control measures

8.2.2 Infection Control Training and Education

Training and education is recommended for both staff members and patients (or
their family and care givers). (Refer to Appendix 5).
8.2.3 Measures for preventing cross infection
Patients with high risk of infection (Hepatitis B, C and HIV) will require special
precautions in disposal of their PD effluent (Refer PD SOP).

8.3 Prevention and Control of Hepatitis B infection

8.3.1 Testing for hepatitis B

The following patients shall be tested for HBsAg:
• New patients with an unknown viral status
• Patients who were negative for anti-HBs with history of recent transfusion of blood/
blood products

8.3.2 Serology Testing

• If HBsAg (and anti-HBs) is negative, it shall be re-tested at least every six (6)
months
• Patients require vaccination if HBsAg and anti-HBs are both negative. (Refer to
section 8.3.3 for vaccine schedule)
• Anti-HBs shall be repeated at least yearly in patients who have responded to
hepatitis vaccination
• If anti HBs<10 mIU/ml a booster dose should be given

8.3.3 Vaccination Schedule

• A four (4) doses double-strength vaccination schedule is recommended at zero
(0), one (1), two (2) and six (6) months according to manufacturer
recommendation
• Serum anti-HBs shall be checked one to two (1-2) months after completion of
the vaccination course
• Those that do not develop anti-HBs response (<10mIU/ml) after primary
vaccination shall be re-immunised. Re-immunisation consists of one to three (1-
3) doses, after which if they remain negative, they are unlikely to respond to
additional doses

8.3.4 Seroconversion
The licensee/person-in-charge shall notify Ministry of Health of any Hepatitis B
seroconversion

8.4 Prevention and Control of Hepatitis C infection

8.4.1 Testing for hepatitis C

The following patients shall be tested for anti-HCV antibody:
• New patients with an unknown viral status
• Patients with history of recent transfusion of blood/ blood products

8.4.2 Serology testing:

• Anti-HCV screening should be made with immunoassay test (e.g. ELISA) and/or
nucleic acid testing (NAT)
 • In anti-HCV negative patients, immunoassay shall be repeated at least every 6
months
• If anti HCV is indeterminate, confirmation can be made with nucleic acid testing
(NAT)
• Confirmed Hepatitis C infected patients do not require repeated serological test

8.4.4 Seroconversion
The licensee/ person-in charge shall notify the Ministry of Health of any Hepatitis C
seroconversion

8.5 Prevention and Control of HIV infection

8.5.1 Patients shall be tested for anti-HIV antibody and/or NAT before initiating PD
treatment

8.5.2 In HIV positive patients, proper management of PD dialysate and disposables

needs to be followed (refer PD SOP)

8.5.3 In HIV negative patients, serologic test shall be performed at least every 6 months

8.5.4 The licensee/person-in charge shall notify the Ministry of Health of any cases of HIV
seroconversion

8.6 Screening and Vaccination of Staff

8.6.1 PD staff should be screened for blood- borne viruses before working in the PD unit

8.6.2 Staff who are HBsAg negative shall be vaccinated:

• if anti-HBs is non-reactive, a full course of vaccination shall be given
• Anti-HBs should be retested 1-2 months after the last dose of the hepatitis vaccine
• if post-vaccination anti-Hbs is < 10 Miu/ml, the vaccine series should be repeated
and antibody retested 1-2 months after second series
• if post-vaccination anti-Hbs antibody is >= 10 Miu/ml, periodic testing or booster
doses of vaccination areis not required

CHAPTER 9: OUTCOME MEASURES AND QUALITY INITIATIVES IN

DIALYSIS

9.1 Reporting to National Renal Registry

All centres shall submit data to NRR in a specified format.

9.2 Peritonitis episodes

• Peritonitis episodes should be monitored monthly
 • Peritonitis rates should not exceed 1: 24 PD patient –months ( do we want to
change to annual rates < 0.5 ?)

9.3 Dialysis Adequacy

• Dialysis adequacy shall be assessed with Kt/V or URR
• Dialysis Adequacy (Kt/V)
o Target: 95% of patients have Kt/V ≥1.7

9.4 Incident Reporting to Ministry of Health

• All hepatitis and HIV seroconversion

CHAPTER 10: DIALYSIS DISASTER QUALITY MANAGEMENT

10.1 Mitigation phase

 The centre should prepare a standard operating procedure (SOP) on Dialysis

Disaster
 PIC should risks- stratify the unit in relation to the potential disaster whether
at high, moderate or low risks
 High risks and moderate risks PD units should identify and inform the
relevant authorities to facilitate patient transfer in the event of disaster
 Patients data should be regularly updated inclusive of latest blood
parameter, medication lists and contact numbers
 Dialysis equipment and facilities ? disposables ( cant move facilities )
should be readily available to be transferred to safe place if needed

10.2 Preparedness phase

 Medical records and dialysis equipment should be placed in safe areas

 Patients and relatives should receive information on the nearest Dialysis
Disaster Relief Centers and mode of safe transfer
 Regular communications with the relevant authorities should be observed in
preparation of evacuation

10.3 Response

 PIC and PD staff should ensure patients receive uninterrupted PD treatment

throughout the disaster period
 Patient whereabouts should be tracked and be documented
 Ensure dialysis equipment and patients’ clinical records are stored in a at
safe place and review the need to relocate.
 Continuously communicate with the relevant authorities on latest disaster
situation.
 PIC/PD manager should provide latest information on the PD unit status with
 regards to the damages, patients, staffs and utilities disruptions to the
relevant health authorities

10.4 Recovery phase

 Assessment of facility and equipment damages should be made and

documented
CHAPTER 11: HOME VISIT

11.1 Each PD unit should have a home visit programme

11.2 The home visit shall be done by the PD nurse

11.3 During the home visit, the PD nurse need to be observe and monitor:

 home environment
 PD exchanges
 PD record book
 PD solution and medication storage
In addition, the PD nurse should pProvides health education

(Refer PD SOP appendix)

CHAPTER 12: PD SATELLITE UNIT

A PD satellite unit may consist of a PD unit in a private hospital, a district hospital or a

government medical clinic. The unit shall have a prior memorandum of understanding
(MOU) with an accredited PD centre to assist in the management of patients. It must
comply with PD quality standards.

A PD satellite unit shall provide holistic care and management of PD patients including
administrative duties, day-to-day troubleshooting for problems (e.g. constipation, leaking,
poor outflow etc), uncomplicated peritonitis, and non-infectious complications of PD. IfThe
unable to provide this service, the unit shall refer patients to the accredited PD centre.

Appendix 1

PD Standard Operating Procedures 2015, Ministry of Health Malaysia

Appendix 2

RRT CPG on management of PD related infections

Appendix 3

Laboratory investigations schedule for PD patients

Laboratory Tests Minimum

Investigation frequency
Haematological Full blood count 3 monthly
Iron Study: 6 monthly
(Ferritin, TSAT)
 Biochemistry Renal Function 3
Test monthly
Liver Function 3
Test :(Albumin, monthly
ALT, ALP) 3 monthly
Calcium, 6 monthly
phosphate 6 monthly
Fasting iPTH
Fasting Serum 3 monthly
Lipid (diabetics)
6 monthly
Blood sugar (non-
diabetics)

HbA1C 6 monthly
(diabetics)

Virology HBs Ag 6 monthly

(refer to section 8.3 Anti HBs titre Yearly
and 8.4 for details) Anti HCV 6 monthly
Anti HIV (in
patients
Hep C
negative)
6 monthly
(in
patients
HIV
negative)

*ALP=alkaline phosphatase, ALT=alanine transaminase, anti-HBs=anti-hepatitis B

surface, anit-HBsAg=hepatitis B surface antigen, anti-HCV=anti-hepatitis C, anti-HIV=anti-
human immunodeficiency virus, HbA1C=glycosylated haemoglobin, PTH=intact
parathyroid hormone, TSAT=transferrin saturation

Appendix 4

PD fluid sampling refer appendix 1 (PD Standard Operating Procedure 2015, Ministry of Health
Malaysia) – if this is already in appendix 1 , not necessary to rpt?

Appendix 5

Infection Control precautions for all patients

(Adapted from CDC guidelines)

• Proper hand hygiene technique

 • Wear disposable gloves when caring for the patient or touching the patient’s
equipment at the dialysis station. Ensure a supply of clean non-sterile gloves and a
glove discard container near each dialysis station
• Wash hands after gloves are removed and between patient contacts, as well as
after touching blood, body fluids, secretions, excretions, and contaminated items
• A sufficient number of sinks with warm water and soap shall be available to facilitate
hand washing
• If hands are not visibly soiled, use of a waterless antiseptic hand rub can be
substituted for hand washing
• Prepare medications in a room or area separated from the patient treatment area
and designated only for medications
• Do not handle or store contaminated (used supplies, used equipment, blood
samples, or biohazard containers) in areas where medications and clean (unused)
equipment and supplies are handled
• Deliver medications separately to each patient. Common carts shall not be used
within the patient treatment area to prepare or distribute medications
• If trays are used to distribute medications, clean them before using for a different
patient
• Intravenous medication vials labelled for single use, including erythropoietin, shall
not be punctured more than once. Once a needle has entered a vial labelled for
single use, the sterility of the product can no longer be guaranteed
• Residual medication from two or more vials shall not be pooled into a single vial
• If a common supply cart is used to store clean supplies in the patient treatment
area, this cart shall remain in a designated area at a sufficient distance from patient
stations to avoid contamination with blood. Such carts shall not be moved between
stations to distribute supplies
• Staff members shall not eat, drink, or smoke in the dialysis treatment area
• Between uses of medical equipment (e.g., scissors, haemostats, clamps,
stethoscopes, blood pressure cuffs), clean and apply a hospital disinfectant (i.e.,
low-level disinfection); if the item is visibly contaminated with blood, use a
tuberculocidal disinfectant (i.e., intermediate-level disinfection).
• For a blood spill, immediately clean the area with a cloth soaked with a
tuberculocidal disinfectant or a 1:100 dilution of household bleach (300-600 mg/L
free chlorine) (i.e., intermediate-level disinfection). The staff member doing the
cleaning shall wear gloves, and the cloth shall be placed in a bucket or other leak
proof container.
• Housekeeping staff members in the dialysis facility shall promptly remove soil and
potentially infectious waste and maintain an environment that enhances patient care
• All disposable items shall be placed in bags thick enough to prevent leakage.

Appendix 6

Recommended training on Infection Control in dialysis

(Adapted from CDC guidelines)

Staff Training
Training and education for all employees at risk for occupational exposure to blood shall
be provided at least annually, given to new employees before they begin working in the
unit, and documented. At a minimum, they shall include information on the following topics:
 Proper hand hygiene technique
 Proper use of protective equipment
 Modes of transmission for blood borne viruses, pathogenic bacteria, and other
microorganisms as appropriate
 Infection control practices recommended for PD unit and how they differ from
Standard Precautions recommended for other health-care settings
 Proper handling and delivery of patient medication
 Centralised record keeping to monitor and prevent complications, including routine
serologic testing results for HBV and HCV, Hepatitis B vaccination status, episodes
of bacteraemia and loss of access caused by infection and other adverse events

Patient and Family Member Training

Training and education of patients (or family members care-givers for patients unable to
be responsible for their own care) regarding infection control practices shall be given on
initiation of peritoneal admission to dialysis and at least annually thereafter.T and shall
address the following topics shall be addressed:
• Personal hygiene and hand hygiene technique
• Patient responsibility for proper care of the PD access and recognition of signs of
infection, which shall be reviewed each time the patient has a ?? PD-related
infection rather than change in PD access ( does change refer to removal and
reinsertion of cath / means change in condition of PD access i.e. ESI or peritonitis )
• Recommended vaccinations

References

1. Standard Operating Procedure Rawatan Peritoneal Dialisis. Kementerian Kesihatan Malaysia

2015.
2. Renal Replacement Therapy. Clinical practice Guidelines. Ministry of Health Malaysia 2017.
3. Centers for Disease Control and Prevention: Infection Control Requirements for Dialysis
Facilities and Clarification Regarding Guidance on Parenteral Medication Vials - MMWR August
15, 2008 / 57(32); 875-876
GLOSSARY OF TERMS AND DEFINITIONS

For the purpose of this standard, the auxiliary verb:

• “shall” means that compliance with a requirement or a test is mandatory for

compliance with this standard;

• “should” means that compliance with a requirement or a test is recommended but is

not mandatory for compliance with this standard;

• “may” is used to describe a permissible way to achieve compliance with a

requirement or test.