We thank you for your interesting question. For the patient/caregiver performing PD exchanges in the home, there are two important aspects of care to consider during connection and disconnection to prevent contamination and possible peritonitis: hand hygiene and aseptic “non-touch” technique (1, 2).
 
For hand hygiene, it is essential to understand that disposable gloves can become contaminated either through micro-tears in the gloves not visible to the naked eye or through the patient’s unwashed hands touching the outside of the glove when pulling on (donning). Both the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) recommend that the use of gloves should not replace the use of hand hygiene (3,4). To prevent contamination and possibility of infection, patients performing PD in the home should be taught the importance of hand hygiene (either with hand washing with soap and running water followed by careful drying with a clean towel or with use of an alcohol-based hand sanitizer with at least 60% alcohol, following CDC guidelines) before commencing or before discontinuing the PD procedure. Note here, that if the patient’s hands are very soiled or greasy (e.g. after handling food or gardening), then hands should always be washed with soap and water, then dried with a clean towel (5). Using gloves without first appropriate hand hygiene as well as not donning gloves correctly could give patients a false sense of safety and result in touch contamination leading to possible peritonitis.
 
For aseptic non-touch technique when performing connection or disconnection during the PD procedure, it is important to teach the patient the correct way to hold the PD connections; that is carefully to avoid touch contamination so that the fingers touch neither the open connection end of the transfer set nor the open connection end of the PD line (2).
 
There are limited review articles or research on the best practices for hand hygiene for patients on PD (6,7). From a small informal survey of members of the ISPD Nursing Committee from different countries (Australia, Brazil, Canada, New Zealand, the U.K. and the U.S.) we found that none of the PD nurses in any of these countries recommended the use of gloves for patients in the home on PD. Of interest, from this informal survey, hand hygiene practices taught to patients on home PD varied: 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.
 
1.Perl J, Fuller DS, Boudville N, Kliger AS, Schaubel DE, Teitelbaum I, Warady BA, Neu AM, Patel PR, Piraino B, Schreiber M. Optimizing peritoneal dialysis–associated peritonitis prevention in the United States: From standardized peritoneal dialysis–associated peritonitis reporting and beyond. Clinical Journal of the American Society of Nephrology. 2021 Jan 7;16(1):154-61. Available at: https://cjasn.asnjournals.org/content/clinjasn/16/1/154.full.pdf
 
2.Miller TE, Findon G. Touch Contamination of Connection Devices in Peritoneal Dialysis-A quantitative Microbiologic Analysis. Peritoneal Dialysis International. 1997 Nov;17(6):560-7.
 
3.Centers for Disease Control and Prevention (CDC) Hand hygiene in health care settings. Updated January 8th Available at: http://www.cdc.gov/handhygiene/providers/index.html#:~:text=Gloves%20are%20not%20a%20substitute,hygiene%20immediately%20after%20removing%20gloves
 
4.World Health Organization. Glove use information leaflet. Updated 2009. Available at:
http://www.cdn.who.int/media/docs/default-source/integrated-health-services-(ihs)/infection-prevention-and-control/hand-hygiene/tools/glove-use-information-leaflet.pdf?sfvrsn=13670aa_10
 
5.Centers for Disease Control and Prevention (CDC). Show Me the Science – When & How to Use Hand Sanitizer in Community Settings. Updated September 10, 2020. Available at:
http://www.cdc.gov/handwashing/show-me-the-science-hand-sanitizer.html
 
6.Firanek C, Guest S. Hand hygiene in peritoneal dialysis. Peritoneal Dialysis International. 2011 Jul;31(4):399-408.
 
7.Figueiredo AE, de Siqueira SL, Poli-de-Figueiredo CE, d’Avila DO. Hand hygiene in peritoneal dialysis patients: a comparison of two techniques. Peritoneal Dialysis International. 2013 Nov;33(6):655-61. Available at: ncbi.nlm.nih.gov/pmc/articles/PMC3862095/pdf/pdi_33_6_012.pdf