Good Morning, when training patients our nursing team has always taught the learners to do a 20 second hand wash with antibacterial soap and water and drying with clean paper towel, before gathering supplies and proceeding with their capd exchange or setting up their cycler. During the exchange procedure and cycler set up we instruct the patients to reinforce the cleanliness of their hands by using sanitizer (after masking) before any sterile connection or disconnection moments. I spoke to a Nurse yesterday who was teaching a patient that if the patient thought her hands weren't soiled, she didn't need to wash with soap and water before gathering her supplies, but to just use sanitizer. My colleague's rational was that our hospital policy stated sanitizer is the superior choice over antibacterial soap and water for "unsoiled hands" and that as this is hospital policy, this should apply to PD patients as well. Is there a best practice guideline for performing PD exchanges that clarifies hand hygiene methods and procedure?
Good Morning, when training patients our nursing team has always taught the learners to do a 20 second hand wash with antibacterial soap and water and drying with clean paper towel, before gathering supplies and proceeding with their capd exchange or setting up their cycler. During the exchange procedure and cycler set up we instruct the patients to reinforce the cleanliness of their hands by using sanitizer (after masking) before any sterile connection or disconnection moments. I spoke to a Nurse yesterday who was teaching a patient that if the patient thought her hands weren't soiled, she didn't need to wash with soap and water before gathering her supplies, but to just use sanitizer. My colleague's rational was that our hospital policy stated sanitizer is the superior choice over antibacterial soap and water for "unsoiled hands" and that as this is hospital policy, this should apply to PD patients as well. Is there a best practice guideline for performing PD exchanges that clarifies hand hygiene methods and procedure?
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Karen A., Nurse from Grand River Hospital asked
Good Morning, when training patients our nursing team has always taught the learners to do a 20 second hand wash with antibacterial soap and water and drying with clean paper towel, before gathering supplies and proceeding with their capd exchange or setting up their cycler. During the exchange procedure and cycler set up we instruct the patients to reinforce the cleanliness of their hands by using sanitizer (after masking) before any sterile connection or disconnection moments. I spoke to a Nurse yesterday who was teaching a patient that if the patient thought her hands weren't soiled, she didn't need to wash with soap and water before gathering her supplies, but to just use sanitizer. My colleague's rational was that our hospital policy stated sanitizer is the superior choice over antibacterial soap and water for "unsoiled hands" and that as this is hospital policy, this should apply to PD patients as well. Is there a best practice guideline for performing PD exchanges that clarifies hand hygiene methods and procedure?

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⋅ Nurse Canada, Nurse United States and members of the ISPD Nursing Committee ⋅ March 8, 2023

We thank you for your question. Last October, to answer another question, we conducted a small survey of members of our ISPD Nursing Committee (Australia, Brazil, Canada, New Zealand, the U.K. and the U.S) and found that practices on teaching hand hygiene to patients on PD do vary, country to country: some recommended washing with soap (usually any brand of liquid soap followed by drying with disposable paper towels, one did recommend liquid anti-bacterial soap); one recommended solely alcohol-based hand sanitizer; two (Canada and the U.K.) recommended initially using liquid hand soap on gathering supplies and setting up for PD, then use of alcohol-based hand sanitizer immediately before connecting. If the home PD patient was on automated peritoneal dialysis (APD) and using a drain line draining into a toilet, then particular attention was paid to teaching the PD patient to repeat hand hygiene after touching the toilet. This is a whole area that would certainly benefit from further research.
 
This US Centers for Disease Control and Prevention does provide detailed advice for hand hygiene in the community, recommending soap and water for hand washing over hand sanitizer not only when hands are visibly soiled, but also for example before and after preparing food, touching animal waste, or touching garbage (1).
 
Also, be aware that alcohol-based hand sanitizers are not as effective as soap and water in removing certain spores such as Clostridioides difficile (C. diff), mostly of concern if there is a C. diff outbreak on a hospital ward, when soap and water for handwashing is preferred (1,2).
 
1.Centers for Disease Control and Prevention (CDC). Hand Sanitizer Use Out and About. Updated: August 10, 2021. https://www.cdc.gov/handwashing/hand-sanitizer-use.html#:~:text=Hand%20sanitizers%20also%20may%20not,and%20heavy%20metals%20like%20lead.
 
2.Doll M, Marra AR, Apisarnthanarak A, Al-Maani AS, Abbas S, Rosenthal VD. Prevention of Clostridioides difficile in hospitals: A position paper of the International Society for Infectious Diseases. International Journal of Infectious Diseases. 2021 Jan 1;102:188-95.Available at:
https://www.sciencedirect.com/science/article/pii/S1201971220322438
 

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