Texas Administrative Code › Title 25 - HEALTH SERVICES › Part 1 - DEPARTMENT OF STATE HEALTH SERVICES › Chapter 117 - END STAGE RENAL DISEASE FACILITIES › Subchapter C - MINIMUM STANDARDS FOR EQUIPMENT, WATER TREATMENT AND REUSE, AND SANITARY AND HYGIENIC CONDITIONS › Section 117.33 - Sanitary Conditions and Hygienic Practices

Current through Reg. 49, No. 28; July 12, 2024
(a) General infection control measures.
(1) Universal precautions.
(A) Universal precautions shall be followed
				  in the facility for all patient care activities in accordance with 29 Code of
				  Federal Regulations, §1910.1030(d)(1) - (3) (concerning Bloodborne
				  Pathogens) and the Health and Safety Code, Chapter 85, Subchapter I (concerning
				  Prevention of Transmission of Human Immunodeficiency Virus and Hepatitis B
				  Virus by Health Care Workers).
(B)
				  The facility shall demonstrate that it follows standard infection control
				  precautions by implementing the Recommended Infection Control Practices for
				  Hemodialysis Units at a Glance, with the exception of screening for Hepatitis
				  C, found in Recommendations for Preventing Transmission of Infections Among
				  Chronic Hemodialysis Patients, Morbidity and Mortality Weekly Report, Volume
				  50, Number RR - 5, April 27, 2001, pages 18 through 22, developed by the
				  Centers for Disease Control and Prevention, to prevent and control
				  cross-contamination and the spread of infectious agents.
(C) Infection control precautions for all
				  patients.
(i) Disposable gloves shall be worn
				  when caring for the patient or touching the patient's equipment or bloodlines
				  at the dialysis station.
(ii)
				  Gloves shall be removed and hands shall be cleaned between each patient
				  contact, as well as after touching blood, body fluids, secretions, excretions,
				  and contaminated items or station. A sufficient number of sinks, with
				  hands-free operable controls, with warm water and soap shall be available to
				  facilitate hand washing. Provisions for hand drying shall be included at each
				  hand washing sink.
(iii) If hands
				  are not visibly soiled, use of a waterless antiseptic hand rub can be
				  substituted for handwashing.
(iv)
				  Staff members shall wear gowns, face shields, eye wear, or masks to protect
				  themselves and prevent soiling of clothing when performing procedures during
				  which spurting or spattering of blood might occur (e.g., during initiation and
				  termination of dialysis, cleaning of dialyzers, and centrifugation of
				  blood).
(v) Staff members shall not
				  eat, drink, or smoke in the dialysis treatment area or in the
				  laboratory.
(vi) Items taken to the
				  dialysis station shall either be disposed of, dedicated for use only on a
				  single patient, or cleaned and disinfected before being taken to a common clean
				  area or used on another patient.
(vii) Nondisposable items that cannot be
				  cleaned and disinfected (e.g., adhesive tape, cloth covered blood pressure
				  cuffs) shall be dedicated for use only on a single patient.
(viii) Unused medications or supplies
				  (syringes, alcohol swabs, etc.) taken to the patient's station shall be used
				  only for that patient and shall not be returned to a common clean area or used
				  on other patients.
(ix) Clean areas
				  shall be clearly designated for the preparation, handling, and storage of
				  medications and unused supplies and equipment. Medications or clean supplies
				  shall not be handled and stored in the same or an immediately adjacent area
				  where used supplies, equipment, or blood samples are handled.
(x) Contaminated areas where used supplies,
				  equipment, or blood samples are handled shall be clearly designated.
(xi) When multiple dose medication vials are
				  used (including vials containing diluents), individual patient doses shall be
				  prepared in a clean (centralized) area away from dialysis stations, and
				  delivered separately to each patient.
(xii) Multiple dose medications vials shall
				  not be carried from station to station.
(xiii) Common medication carts shall not be
				  used to deliver medications to patients. If trays are used to deliver
				  medications to individual patients, they shall be cleaned between each
				  patient.
(xiv) If a common supply
				  cart is used to store clean supplies in the patient treatment area, this cart
				  shall remain in a designated area at a sufficient distance from patient
				  stations to avoid contamination with blood. Such carts shall not be moved
				  between stations to distribute supplies.
(xv) Medication vials, syringes, alcohol
				  swabs or supplies shall not be carried in pockets.
(D) Location and arrangement of hand washing
				  sinks shall permit ease of access and proper use.
(E) Facility staff shall explain the
				  potential risks associated with blood and blood products to patients and family
				  members and provide the indicated personal protective equipment to a patient or
				  family member, if the patient or family member assists in procedures which
				  could result in contact with blood or body fluids.