Questions About PD
We thank you for your excellent question. It is most important to note that today, across all healthcare settings, we should all be practicing “standard precautions” incorporating the major features of “universal precautions” and “body substance isolation”. Standard precautions are both to protect all health care workers from transmission of infectious agents (via patients) and to protect all patients from transmission of infectious agents (via health care workers). Standard precautions include: hand hygiene; use of gloves, gown, mask, eye protection or face shield, depending on the anticipated exposure; and safe injection practices. Which of these standard precautions should be utilized depends on the type of interaction between the health care worker and the patient (1). Occupational transmission of human immunodeficiency virus (HIV) to health care workers in the U.S. is rare (2). Proper use of standard precautions is considered by the U.S. Centers for Disease Control and Prevention (CDC) sufficient to minimize transmission of HIV in the health care setting and they feel it is not necessary to isolate a patient with HIV on dialysis (3).
Now, the HIV has been identified to be present in the peritoneal dialysis (PD) effluent of patients infected with HIV on PD (4). Thus, when disposing of PD effluent, as well as usual hand hygiene and use of disposable gloves, the eyes and face of the health care worker or family member should also be protected (splash protection). Of note, while the PD effluent is draining into the toilet (not the sink), the tubing from the bag should be placed below the surface of the water to help prevent splashing while the bag drains. Patients/family members should also be taught that, once home, used PD bags and tubing should be placed in a plastic bag, the bag sealed (twist and tie with a knot securely to prevent any leakage if inverted). For extra security against leakage, the bag may then be placed in another plastic bag (double-bagging), before being discarded with household waste (unless the community/dialysis unit has other directions). Any inadvertent spills or splashes of PD effluent on surfaces should be disinfected with 1:10 dilution household bleach (4,5). After disposing of PD effluent or cleaning up any spills, the health care worker/family member should be taught to remove and discard the disposable gloves, and again thoroughly wash his/her hands, then dry them well. It is always an option to train a patient with HIV in his or her home (as with patients who have the hepatitis B virus).
While the focus is on prevention of occupational exposure to HIV, it is an urgent medical concern should it occur and the CDC also has recommendations for prophylactic post-exposure management and treatment for health care workers after occupational exposure to HIV available at https://www.cdc.gov/hiv/risk/pep/index.html Dialysis facilities should have a plan in place for post-exposure management of health care workers.
- Guidelines for Using HIV Testing Technologies in Surveillance: Selection, Evaluation and Implementation: 2009 Update. Geneva: World Health Organization; 2009. Appendix, Standard Precautions for Prevention of Transmission of HIV, Hepatitis B Virus, Hepatitis C Virus and Other Bloodborne Pathogens in Health-Care Settings. Available at: https://www.ncbi.nlm.nih.gov/books/NBK305277/
- Centers for Disease Control. Occupational HIV Transmission and Prevention among Health Care Workers (June 2015). Available at: https://www.cdc.gov/hiv/pdf/workplace/cdc-hiv-healthcareworkers.pdf
- Centers for Disease Control. Recommendations for Preventing Transmission of Infections Among Chronic Hemodialysis Patients (April 2001). Available at: https://www.cdc.gov/mmwr/preview/mmwrhtml/rr5005a1.htm
- Farzadegan, H., Ford, D., Malan, M. et al. HIV-1 survival kinetics in peritoneal dialysis effluent. Kidney Int 1996; 50: 1659-62. Available at: http://www.kidney-international.org/article/S0085-2538(15)59776-7/pdf
- Centers for Disease Control. Infection Control for Peritoneal Dialysis (PD) Patients After a Disaster (2005, updated 2014). Available at: http://www.cdc.gov/disasters/icfordialysis.html