Table 2.

Summary of Key Infection Control Observations

Infection control area	Tools used	Positive practices	Selected suboptimal practices
Hand hygiene (HH)14,18	http://www.cdc.gov/dialysis/prevention-tools/	Staff successfully used 72 (82%) of 88 observed HH opportunities Good HH before and after medication administration Good HH when leaving patient stations	HH duration and thoroughness were not always adequate HH not performed in between touching the patient during a vascular access procedure and touching the machine's screen/keyboard HH inconsistently performed before gloving One doctor was seen not performing HH before or after direct contact with patients
Medication preparation and administration14,19,20	http://www.cdc.gov/injectionsafety/IP07_standardPrecaution.html http://www.cdc.gov/injectionsafety/providers/provider_faqs.html	Separate room used for medication preparation (although a cart was used in patient care area before December 2012) Generally good HH and glove use when administering medication	Catheter hubs and vial tops were not scrubbed vigorously with antiseptic swab Medication preparation was performed next to a sink, which could cause exposure to water splash
Vascular access care14,21–23	http://www.cdc.gov/dialysis/prevention-tools/	Consistent use of face shields and gloves	Staff usually touched multiple objects (eg, screen, keyboard) with the same gloves between steps of the access procedure Staff were seen not performing HH before donning gloves for cannulation and needle removal procedures Cleanliness and rigorousness of antiseptic application varied
Cleaning and disinfection14,24,25	http://www.cdc.gov/dialysis/prevention-tools/	Some staff performed cleaning thoroughly Most times dialysis chairs were observed to be visibly wet with disinfectant	Most dialysis machines were wiped with disinfectant while patient who just completed treatment was still in the chair Staff did not consistently check the machine for visible soil/blood before cleaning Staff cleaned and disinfected the machines when potentially contaminated items were still on the side table, very close to the machines being cleaned The machines were visibly wet with disinfectant in only 2 of 9 observed cleaning sessions Vigorousness of wiping varied Cleaning and disinfection procedures were not performed in a standard manner There were usually missed or undercleaned areas, eg, priming bucket and chair’s side tables; the priming bucket was rarely disinfected during observation