CMS SOM App. H, Tag V113

Wear disposable gloves when caring for the patient or touching the patient’s equipment at

the dialysis station. Staff must remove gloves and wash hands between each patient and

station.

Interpretive Guidance § 494.30(a)(1)(i)

According to the CDC, hand washing is the most effective measure to prevent the transmission of

contaminants.

Because exposure to blood and potentially contaminated items can be routinely anticipated

during hemodialysis, gloves are required whenever caring for a patient or touching the patient’s

equipment. To facilitate glove use, a supply of clean non-sterile gloves and waste receptacles

should be readily accessible to each dialysis station and work area. Gloves should be changed

frequently during patient care.

Examples of when gloves should be worn:

• Staff members must wear gloves while performing procedures that have the potential for

exposure to blood, dialysate, and other potentially infectious substances. This includes

procedures such as caring for patients’ vascular accesses or catheters, setting up

reprocessed dialyzers pre dialysis treatment, inserting or removing the vascular access

needles, connecting the dialysis blood lines to the vascular access needle lines or

catheter lines, touching the dialysis blood lines, dialyzer, or machine during or after a

dialysis treatment, administering intravenous medications, handling blood lines,

dialyzers, dialysate tubing and machines post dialysis treatment, and cleaning and

disinfecting the dialysis machine and chair post dialysis treatment.

• Gloves should be provided to patients and visitors if these individuals assist with

procedures that risk exposure to blood or body fluids, such as self-cannulating or holding

access sites post-treatment to achieve hemostasis.

• Chair-side computer keyboards/screens can easily become contaminated because of their

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proximity to the patient station. Hand hygiene is imperative after contact with the chair-side computer and before contact with the patient, regardless of whether contact with the

computer occurred through gloved or ungloved hands.

Examples of when gloves should be changed:

• When soiled (e.g., with blood, dialysate, or other body fluids);

• When going from a “dirty” area or task to a “clean” area or task.

Note: A dirty area is defined as an area where there is a potential for contamination

with blood or body fluids and areas where contaminated or used supplies, equipment,

blood supplies, or biohazard containers are stored or handled. A clean area is an area

designated for clean and unused equipment, supplies, and medications.

• When moving from a contaminated body site to a clean body site of the same patient, and,

• After touching one patient or their machine and before arriving to care for another

patient or touch another patient’s machine.

In addition, gloves must be changed between each patient and station; accordingly, if there is a

change in patient and/or station, a new pair of clean gloves must be used each time for access

site care, vascular access cannulation, administration of parenteral medications or to perform

invasive procedures. The intention is to ensure that clean gloves, which have not previously

touched potentially contaminated surfaces, are in use whenever there is a risk for cross-contamination to a patient’s bloodstream to occur.

“Hand hygiene” refers to either washing hands with soap and water or using a waterless,

alcohol-based antiseptic hand rub with a 60-90% alcohol content. Hands should be washed with

soap and water if visibly soiled. If not visibly soiled, hand hygiene with alcohol-based hand rub

may be used. The CDC recommends that hand washing involve rubbing hands together

“vigorously” for 15 seconds, and that the use of alcohol-based rubs involves covering all

surfaces of hands and fingers until the hands are dry. According to the CDC, even with glove

use, hand hygiene is necessary after glove removal because hands can become contaminated

through small defects in gloves and from the outer surface of gloves during glove removal.

Resources: Hand Hygiene Guidance; Hand Hygiene for Dialysis Care.

Examples of when hand hygiene should be performed:

• After touching blood, body fluids, secretions, excretions, and potentially contaminated

items;

• Before and after direct contact with patients;

• Before performing any invasive procedure such as vascular access cannulation or

administration of parenteral medications;

• Immediately after gloves are removed;

• After contact with inanimate objects, including medical equipment or environmental

surfaces at the patient station;

• Before entering and on exiting the patient treatment areas, and,

• When moving from a contaminated body site to a clean body site of the same patient.

The CDC document, “Prevention of Intravascular Catheter-Related Infections” (“RR-10”),

which is also incorporated into the applicable regulations, states that staff should wear clean or

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sterile gloves when changing the dressing on intravascular catheters. Staff must observe hand

hygiene before and after palpating catheter insertion sites, as well as before and after accessing

or dressing an intravascular catheter.

Hand hygiene is required after every direct contact with a patient and between patient contacts,

even if the contact is casual. Gloves are not necessary for casual social contact with a patient,

for example, staff members may touch the patient’s shoulder, take their arm, or shake hands

without wearing gloves. However, gloves should always be worn anytime contact with blood or

body fluids is anticipated.

Supplies of gloves should be strategically placed so that staff have adequate access for both

routine and emergency use.

Physicians and non-physician practitioners, social workers and dietitians must follow these same

requirements for glove use and hand hygiene if providing direct patient care or when in contact

with patients.