Kidney dialysis is a complicated process requiring clean-up after each patient’s treatment. In the past, nurses at The National Kidney Foundation (NKF) used the same priming bucket to collect the saline solution, soiled bloodlines and dialysers after each dialysis treatment. However, it was found that the use of common priming buckets at the patients’ stations created multiple opportunities for cross-contamination of blood-borne pathogens and other organisms.

To tighten infection control, NKF conducted a quantitative study to review existing practices in eight dialysis centres. Between August to November 2017, the study found that patient safety was compromised as 97 per cent of the buckets were not effectively cleaned after use. A Nursing Infection Taskforce comprising 12 nurses, doctors and seven administrators from Infection Control, Quality Management and Nursing Operations departments, was formed immediately to address the issues.

“The findings clearly showed that we had inadequate infection control practices and action needed to be taken quickly,” says Senior Clinical Nurse Manager Jamilah Binte Jantan.

The team approached dialysis care providers including Singapore General Hospital and Fresenius Medical Care to gain insights on their infection control practices.

“The knowledge-sharing helped us to brainstorm and propose interventions which would meet our operational needs,” Jamilah says.

Some of the key changes made by the team include implementing a new system of waste management based on stringent infection control guidelines, introducing disposable plastic bags to collect waste and soiled equipment after each dialysis and replacing priming buckets with biohazard bins.

With the new waste management system in place, nurses now dispose each plastic bag immediately after one use. This eliminates the risk of cross-contamination between patients’ stations. It also enables nurses to spend more time caring for their patients as they no longer need to spend time transporting and cleaning the buckets.

On average, it is estimated that nurses save about 147 man hours per month with the new system in place. The new system, which was first implemented in eight dialysis centres in 2017, has since been rolled out across all 36 NKF dialysis centres.