Workplace Safety, Patient Safety and Health Care Employment Issues

There is risk for employees who provide dialysis care to patients, as there is in any other healthcare setting. The employees may be exposed to falls, back injuries from lifting heavy patients, infectious diseases, and sharps. These potential injuries can result in lost employee time, and also in costly worker's compensation settlements, so it is vital to establish written guidelines for staff to prevent basic safety pitfalls that can crop up every day.

Keeping the employees' knowledge current is just one component of maintaining a safety program, for staff is the backbone of a dialysis facility. Many professional associations are often willing to help, and can provide free educational materials to make the process easier.

The American Nephrology Nurses' Association (ANNA) is a professional association that incorporates safety into many of the association's educational programs, publication, affiliations and health policy initiatives. ANNA recognizes that safety is complex and is not a distinct and separate topic from the rest of hospital policy. The association recognizes that it is the responsibility of individual institutions to develop and maintain clear and effective safety protocols. These protocols must be customized for each individual setting – whether it is an in-hospital or an outpatient clinic. It is not ANNA's role to determine policies and procedures, but rather to provide important education tools that emphasize safety not only for dialysis staff but for the dialysis patients as well. ANNA supports dialysis institutions in creating a culture of safety and establishing processes and systems that result in the delivery of error-free, safe dialysis treatments through continuous quality improvement. ANNA's resources are available on the association's web site, www.annanurse.org.

Infection Control

Employees may be at risk for various infectious diseases through contact with patients and their bodily fluids. They may contract methicillin-resistance staphylococcus aureus (MRSA), tuberculosis, hepatitis B virus (HBV), hepatitis C virus (HCV) or human immunodeficiency virus (HIV). It is even suspected that in 2003, dialysis patients were responsible for helping to spread severe acute respiratory syndrome (SARS) in Hong Kong and Singapore. "Another hemodialysis patient has been involved in the transmission of SARS in Toronto; therefore, such patients, who may have a relatively depressed immune system with associated high viral loads, may be unduly facilitating transmission of the virus. A more direct role of hemodialysis patients in the spread of viral infections has been previously observed in Edinburgh, Scotland, in the late 1960s, where transmission of hepatitis B was associated with mortality rates of 24 percent and 31 percent in renal patients and staff members, respectively," reported the CDC in September 2003 (CDC, 2003).

In the health care setting, blood-borne pathogen transmission occurs predominantly by percutaneous or mucosal exposure of workers and patients to blood or body fluids of infected patients. Occupational exposures that may result in transmission include needlestick and other sharps injuries; direct inoculation of virus into cutaneous scratches, skin lesions, abrasions, or burns; and inoculation of virus onto mucosal surfaces of the eyes, nose, or mouth through accidental splashes. MRSA, HBV, HCV and HIV do not spontaneously penetrate intact skin, and airborne transmission of these viruses does not occur.

Even though awareness of hepatitis is high, the virus is still a risk. "The prevalence of anti-ACV [antibodies to hepatitis C virus] among persons on dialysis is consistently higher than in other hospitalized patient group. The prevalence of anti-HCV among dialysis patients ranges from eight to 36 percent in the United States and one to 47 percent