We thank you for your question. To the best of our knowledge, ISPD has not provided guidance on the minimum conditions to consider for a safe area in the patient’s home for home PD. There are only a very limited number of studies where the researchers have specifically examined the effect of the actual living environment on outcomes for patients on PD with very low incomes living in remote/rural communities. In the retrospective, single-center study from a rural community in South Africa, the researchers suggested that anemia and poor nutrition led to poor outcomes; home visits and retraining were thought to improve outcomes (1). In the retrospective multi-center study from Columbia, the researchers indicated that remote PD centers could provide safe and favorable patient and technique survival outcomes for patients in isolated rural communities. Of note, each of these remote PD centers in Columbia had a specialized PD nurse who was available at all times for patient training, nursing care, and home visits (2). It is possible that support for these patients on PD in remote areas is more important for positive outcomes than the patient’s physical home environment.
 
From an informal poll of members of the ISPD Nursing Committee, a simple, inexpensive strategy to ensure a “safe” area in the home for CAPD exchanges, is for the patient to have a surface in the home that can be kept clean and easily cleaned before each exchange. A glass cover or large plastic tray just for CAPD exchanges is also suitable. The patient on PD should be taught to clean this surface or tray before each exchange with a disinfectant wipe, or a cloth soaked in a diluted bleach solution, 70% alcohol, or even soap and water. Hand hygiene is paramount and a simple plastic timer can help ensure the patient washes his or her hands for the appropriate amount of time before each exchange.
 
1.Isla RA, Mapiye D, Swanepoel CR, Rozumyk N, Hubahib JE, Okpechi IG. Continuous ambulatory peritoneal dialysis in Limpopo province, South Africa: predictors of patient and technique survival. Peritoneal Dialysis International. 2014 Jul;34(5):518-25.
 
2.Sanabria M, Devia M, Hernández G, Astudillo K, Trillos C, Uribe M, Latorre C, Bernal A, Rivera A. Outcomes of a peritoneal dialysis program in remote communities within Colombia. Peritoneal Dialysis International. 2015 Jan;35(1):52-61.