CMS SOM App. H, Tag V115

Page 10 of 420

Staff members should 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). Staff members should not eat, drink, or smoke in

the dialysis treatment area or in the laboratory.

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

In addition to wearing gloves, staff should wear personal protective equipment (PPE)

appropriate to the anticipated potential exposure. Staff should wear PPE during the initiation

and termination of dialysis treatment, manipulation of access needles or catheters,

administration of medications through the extracorporeal circuit or by subcutaneous injection,

the reprocessing of dialyzers, and cleaning and disinfecting of patient care supplies and

equipment. Protective clothing or gear must be changed if it becomes soiled with blood, body

fluids (including dialysate), secretions, or excretions.

Street clothes, scrub suits, or uniforms are sufficient attire within the dialysis unit, except during

times when the spurting or spattering of blood, body fluids, potentially contaminated substances,

or chemicals may occur. At those times, a cover garment that provides a fluid-resistant barrier

must be worn. This could be a lab coat, a gown, or an apron that incorporates sleeves. The

garment must be closed in front when used during patient care. The protective garment should

fully cover the arms and torso from the neck area to the thigh/knee area. Aprons without sleeves

are insufficient PPE for procedures that may result in blood spattering.

Physicians, advanced practice registered nurses, physician assistants, social workers and

dietitians must wear a cover garment which provides a fluid resistant barrier with full coverage

of arms and body front if they are providing service to any patient in the treatment area during a

time of high risk for spurting or spattering of blood, as, for example, during initiation or

termination of dialysis. The garment should be changed if it becomes soiled. Visitors should be

provided with cover garments if they are in the treatment area during initiation or termination of

dialysis.

Home patients do not have to wear gowns when they are caring for themselves. The partner or

caregiver of a home patient should wear appropriate PPE, including gloves, and practice

appropriate hand hygiene.

Separate PPE (gown, face shield, etc.) should be used in the isolation area/room and removed

before leaving the isolation area/room. “Separate” refers to PPE that is dedicated for use in the

isolation room for the particular patient. If a patient’s family member or other visitors are

accessing the isolation area, staff should provide these individuals with barrier PPE to be worn

during the visit and removed when leaving.

The “treatment area” refers to the physical space where dialysis treatments are administered in

the dialysis unit, including the reuse room and home training area. Staff must avoid any activity

that could lead to self-contamination, such as applying lip balm or handling/inserting contact

lenses in the treatment area. Patients may eat and drink at their dialysis stations, depending on

Page 11 of 420

facility policies. If non-disposable dishes are provided by the facility, they should be cleaned in

the usual manner; no special care is needed for these items.