Page 117 - policy and procedure infection control

Policies and Procedures on Infection Control

3. On the day of catheter insertion, the patient should shower using 4% aqueous
chlorhexidine applied to their whole body to reduce skin flora.
4. Prophylactic antibiotics are indicated, at the discretion of the renal physician, before
insertion of the catheter.
5. If the patient has concurrent skin sepsis, insertion must be delayed until the skin is
normal.
6. If this is not possible, an antibiotic active against the causative organism should be
administered just before catheter insertion and continued for 24 hours.
7. The intra-abdominal catheter must be inserted with full aseptic precautions.

6.4.14 Care of the CAPD system
1. The patient must receive adequate instruction on how to change the dialysis bags
and how to maintain the exit with aseptic precautions at all times.
2. Patients should not immerse or wet the exit site during bathing. It is easier to keep
the exit site dry by showering.
3. Only sterile pyrogen-free dialysate fluid designed for CAPD must be used.
4. If dialysis bags must be warmed, it should be done in a dry heating system and
water baths must not be used.
5. Hands must be cleaned with chlorhexidine skin cleanser or alcoholic chlorhexidine.

6. The exit site must be cleaned and dressed daily using 10% aqueous providon iodine
or 0.5% chlorhexidine. The exit site should be patted dry after cleansing. Gentamicin
cream should be applied to the exit site after cleansing.
7. All dried blood and secretions must be removed using fresh gauze swabs before
each application of skin disinfectant. However it is important not to forcibly remove
crusts or scabs during cleansing as this would cause a break in the skin and may
lead to exit site infection.
8. The exit site is covered with a sterile non-occlusive dressing.
9. The connecting tubing and connectors must be changed approximately 6 monthly
by the renal unit staff.

10. The catheter and proximal tubing must be securely anchored to the abdominal wall
to prevent unnecessary movement around the exit site.

Recurrent CAPD infection

1. Patients who develop more than two to three infections per year should have their infection
control techniques review and receive additional instruction in the prevention of peritonitis.

2. Infection with unusual environmental pathogens may require a review of those procedures
carried out at the patient’s home.

106 Ministry of Health Malaysia