National Center for Emerging and Zoonotic Infectious Diseases

Division of Healthcare Quality Promotion

Select proper disinfectant(s) and determine 

correct dilution(s) for routine use. 

 Use only Environmental Protection Agency (EPA)-

registered hospital disinfectantsa. 

o EPA-registered hospital disinfectants have label 

instructions explaining how they should be used 

in healthcare settings. 

o EPA-registered sodium hypochlorite or other 

products for healthcare settings are available 

and are preferred over household bleach 

products that are not EPA-registered for 

disinfection of surfaces. 

 Low-level vs. intermediate-level disinfection: 

o Routine disinfection of environmental surfaces 

can be accomplished using a low-level 

disinfectant (any EPA-registered hospital 

disinfectant). However, intermediate-level 

disinfectants must be available in the dialysis 

facility for disinfection of surfaces that are visibly 

soiled with blood or body fluids. 

o Intermediate-level disinfectants are sufficiently 

potent to inactivate mycobacteria and have a 

tuberculocidal label claim, whereas low-level 

disinfectants are not strong enough to inactivate 

these bacteria. 

o For convenience, consider selecting and 

routinely using hospital disinfectants that are 

tuberculocidal or have label claims of activity 

against hepatitis B virus (HBV) and human 

immunodeficiency virus (HIV). These products 

may be used to perform routine and 

intermediate-level disinfection. 

 Identify and instruct staff on the correct dilution of 

the disinfectant agent. 

o Read the label carefully and follow the 

manufacturer’s label instructions for proper 

dilution of the disinfectant. Note, label-specified 

dilutions for EPA-registered sodium hypochlorite 

(i.e., bleach) products might not necessarily 

conform to a 1:100 or 1:10 dilution. The 

manufacturer’s instructions are specific to the 

product and should be followed. Some products do 

not require preparation or dilution and are sold as 

“ready to use.”

o Products with tuberculocidal, HBV, and HIV label 

claims will also have instructions for cleaning blood 

spills. 

Establish procedure for disinfecting dialysis 

station between patients.

 Identify responsible staff. 

 Ensure procedure allows for sufficient disinfectant to 

be applied to surfaces (surfaces should be visibly wet). 

 Employ strategies to optimize cleaning and 

disinfection of the station.

o A sufficient patient-free interval is necessary at 

each station to facilitate adequate cleaning and 

disinfection. Routine surface disinfection should 

not commence until the patient has left the 

station. 

o A facility-wide patient-free interval between 

treatment shifts should be considered to ensure 

thorough disinfection of surfaces at the dialysis 

station and to minimize lapses in infection 

prevention that can occur when processes are 

performed in a hurried manner. 

o Routine disinfection of surfaces at the station 

should occur with no patient present to reduce the 

opportunities for cross-contamination and to avoid 

exposing patients to disinfectant fumes. 

 Important considerations regarding moving patients 

to a post-treatment seating area to facilitate more 

rapid station turnover: 

o Patients should not be removed from the station 

until they have completed treatment and are 

clinically stable. If a patient cannot be moved 

safely, disinfection of the dialysis station should be 

delayed until the station can be vacated in a safe 

manner. 

Environmental Surface Disinfection in 

Dialysis Facilities: Notes for Clinical Managers 
o If patients are moved to a separate seating area 

prior to removing cannulation needles or while 

trying to achieve hemostasis, the chairs and 

armrests in those areas must be disinfected in 

between patients. Avoid creating new 

opportunities for contamination of shared 

surfaces with blood or body fluids. 

 Establish procedure for cleaning and disinfection of 

priming buckets. 

o Process should include emptying, cleaning (e.g., 

if blood is present), disinfection, and air-drying 

of bucket. 

o Disinfected priming buckets should be dry before 

reattaching to machine or use.

 Establish procedure for cleaning and disinfection of 

reusable supplies. 

 Disposable medical supplies brought to the dialysis 

station should be discarded. 

o CDC recommends discarding these supplies 

instead of dedicating them to a patient. 

o Discard and dispose of these supplies in 

accordance with your state’s regulated medical 

waste regulations.

 For equipment such as computer touchscreens and 

keyboards, check with the manufacturer for 

instructions and compatibility of equipment with 

disinfecting agent. 

 Determine staff personal protective equipment 

(PPE) needs based on disinfectant product labels. 

Ensure staff have been properly trained on:

 Dialysis station cleaning/disinfection protocol; 

 How to prepare the appropriate “use-dilution” of 

the disinfectant; 

 Application of sufficient disinfectant to achieve 

visibly wet surfaces per the product label; 

 Proper use of PPE (e.g., gloves, gown); and 

 Management of routine disinfection vs. surfaces 

with visible soil or bloodb

.

Ensure that staff have access to proper 

supplies, which should include: 

 Leak-proof disposal containers; 

 Gloves; 

 Other appropriate PPE based on product label 

instructions; 

 Properly diluted EPA-registered hospital 

disinfectants for routine/intermediate-level 

disinfection; and 

 Wipes, cloths, spray bottles and/or buckets. 

Footnotes and Select References: 

a

 Environmental Protection Agency. (2012, Oct 22). 

Selected EPA-registered Disinfectants. Retrieved from 

http://www.epa.gov/oppad001/chemregindex.htm. 

b

 Centers for Disease Control and Prevention. Guidelines 

for Environmental Infection Control in Health-Care 

Facilities. MMWR 2004;52(RR10):1-42.

For machines that are equipped with waste-handling 

option ports, see references below: 

 Jochimsen EM, Frenette C, Delorme M, Arduino M, 

Aguero S, Carson L, Ismaïl J, Lapierre S, Czyziw E, 

Tokars JI, Jarvis WR. A cluster of bloodstream 

infections and pyrogenic reactions among 

hemodialysis patients traced to dialysis machine 

waste-handling option units. Am J Nephrol 1998; 18 

(6): 485-9.

 Wang SA, Levine RB, Carson LA, Arduino MJ, Killar T, 

Grillo FG, Pearson ML, Jarvis WR. An outbreak of 

gram-negative bacteremia in hemodialysis patients 

traced to hemodialysis machine waste drain ports. 

Infect Control Hosp Epidemiol 1999; 20 (11): 746-51.

 CDC. Outbreaks of Gram-Negative Bacterial 

Bloodstream Infections Traced to Probable 

Contamination of Hemodialysis Machines -- Canada, 

1995 United States, 1997; and Israel, 1997. MMWR 

1998;47(03);55-5.