Module 10 — Infection Control and Hemodialysis Complications

Sources: Condensed study notes based on Core Curriculum for the Dialysis Technician, 7th ed. (MEI), plus free CDC/CMS/NIDDK resources.

Infection-control foundation

Study guide

Infection prevention is part of every dialysis task: hand hygiene, clean/dirty separation, appropriate PPE, aseptic technique, environmental disinfection, vaccination, and prompt reporting.
The chain of infection can be interrupted at the source, route, or susceptible host. Dialysis increases opportunity for spread because blood, invasive access, shared equipment, and repeated patient contact are routine.
Standard precautions apply to every patient and every exposure to blood, body fluids, non-intact skin, and mucous membranes, regardless of diagnosis. Add transmission-based precautions when the organism or symptoms require them.
Hand hygiene is required before and after patient contact, before aseptic work, after glove removal, after contact with blood/body fluids or contaminated surfaces, and when moving from dirty to clean work. Gloves never replace hand hygiene.
PPE is selected by the anticipated exposure: gloves for contact, gown/apron for clothing or skin contamination, mask/eye protection for splash or spray, and a fit-tested respirator when policy calls for airborne protection. Don without contaminating yourself; remove the dirtiest items carefully and perform hand hygiene between steps as required.
Cleaning removes soil; disinfection reduces pathogens on an already-clean surface. Use the approved product, wet the surface for its full contact time, respect compatibility instructions, and do not return clean supplies to a contaminated area.

Why answers are correct

A visible spill or dirty glove is only one part of the hazard. Hands, cuffs, machine surfaces, chair controls, medication areas, and shared equipment can silently carry organisms.
Breaking one link—especially hand-to-surface or surface-to-patient transfer—can prevent an outbreak.

Limitations / traps

“Looks clean” does not mean disinfected. Do not wear contaminated gloves into clean areas, touch clean supplies with used PPE, or shortcut contact time.
Follow the product label and clinic policy rather than substituting alcohol, bleach, or a familiar wipe from memory.

Clinical pearl / safety

Keep clean and dirty workflows physically separated. If a sequence is interrupted, pause, re-establish hand hygiene/asepsis, and ask the nurse when unsure.

Exam cue

Standard precautions for all; add transmission precautions by risk; hygiene before gloves and after removal.

Transmission precautions and special infections

Study guide

Symptomatic patients should be masked and kept away from general waiting areas when possible. Use a private room or cohort patients with the same suspected infection during an outbreak; a separate shift or better-ventilated space may be used by policy.
Hepatitis B is a major dialysis concern because it can persist on apparently clean surfaces and equipment. A patient with positive HBsAg requires isolation precautions, a dedicated room/machine/equipment, and staff who are not simultaneously caring for susceptible patients. Staff caring for HBV-positive patients should be immune per policy.
HBV testing and vaccination protect patients and staff; susceptible dialysis patients may require an enhanced schedule and ongoing testing. Hepatitis C has no vaccine, so prevention depends on bloodborne precautions and surveillance.
HIV does not require dedicated dialysis machines when standard infection-control precautions are followed; avoid stigma and use the same safe-care standards for every patient.
Bloodborne infections of particular concern include HIV/AIDS, HBV, and HCV. Report exposures immediately so testing and post-exposure prophylaxis (PEP), when indicated, can begin.

Why answers are correct

HBV survives in the environment more effectively than many other bloodborne viruses; dedicated isolation controls the route between contaminated surfaces, staff, and susceptible patients.
The correct response to HIV/HCV risk is rigorous standard precautions, not unnecessary isolation or discrimination.

Limitations / traps

Do not care for HBV-positive and susceptible patients on the same shift when policy prohibits it. Do not infer immunity from a past vaccine dose; use documented status/testing.

Clinical pearl / safety

A needlestick or splash is an emergency exposure: wash/flush immediately with water, report to the manager/nurse, and follow the exposure pathway. Do not delay reporting to see whether symptoms develop.

Exam cue

HBsAg-positive patient: isolation, dedicated equipment, immune staff; HIV: standard precautions, no dedicated machine solely for diagnosis.

Sharps, aseptic technique, medication, and waste

Study guide

Use FDA-approved sharps containers at each station; keep them upright, within reach, closed/sealed when full, and never overfilled. Prefer safety-engineered and needle-free devices when available.
Plan disposal before starting. Point needles away from people, activate the safety feature immediately after use, never bend/shear/break a needle, and never reach into or shake a sharps box. If recapping cannot be avoided by policy, use a one-handed or mechanical method.
An accidental stick requires immediate washing with soap and water and prompt reporting. PEP and follow-up testing are clinician-directed.
Injectable medicines require hand hygiene and aseptic technique. Use only a labeled medicine that is ordered and within the worker’s legal scope; a wrong drug or dose can seriously harm a patient. Never move vials from station to station or reuse single-dose/single-use vials, syringes, cartridges, or tubing.
Keep a dedicated clean medication-preparation area with handwashing supplies, clean counters, and a medicine-only refrigerator. Items taken to a patient station are considered contaminated and do not return to the clean area.
After treatment, disposable blood-contaminated items go into the correct labeled, leak-resistant biohazard stream; sharps, needles, syringes, and blood tubing go into approved sharps containers. Shared equipment is minimized and disinfected before reuse.
Do not begin station cleaning until the patient has left. Stop, clamp, or secure equipment as required; protect yourself from blood and cleaning chemicals.

Why answers are correct

The sterile pathway may go directly into a patient. A clean-looking vial, syringe tip, port, or package is unsafe if its sterile barrier or label is uncertain.
Sharps containers and waste bags protect every worker downstream, not just the person who created the waste.

Limitations / traps

“It was only used once” does not make a single-use vial reusable. Never give an unlabeled medication or perform a task outside authorization.

Clinical pearl / safety

When in doubt about package integrity, medication identity, or disposal: discard/isolate it according to policy and ask the nurse or supervisor.

Exam cue

Clean area stays clean; sharps are never recapped by hand; contaminated items are discarded, assigned, or disinfected before reuse.

Acute dialysis emergencies

Study guide

Air embolism: suspect with neurologic change, chest symptoms, dyspnea, cyanosis, bubbles/foam, arrhythmia, or collapse. Prevent with an air-free primed circuit, full chambers, secure connections, working air detector, and no dry saline bag. Call for help, clamp the venous line, stop the blood pump, position per policy (often left side and Trendelenburg/supine), and support oxygen/911 response. Never ignore microbubbles or an alarm.
Allergic reaction/anaphylaxis: reactions can occur to dialyzer, sterilant, medication, disinfectant, or blood product. Early reactions often occur soon after blood enters the circuit; severe reactions can include wheeze, rash, flushing, hypotension, abdominal symptoms, angioedema, shock, or arrest. Call the nurse; do not return blood or remove needles unless directed, because access may be needed for emergency medication. Support oxygen and emergency treatment.
Blood loss/exsanguination: access dislodgement, tubing separation, loose connections, or hidden bleeding can cause shock rapidly. Keep access visible, check hemostasis before discharge, stop the pump and apply direct pressure when bleeding occurs, call for help, and follow the emergency blood-loss protocol.
Hemolysis: red-cell rupture may result from contaminated/overheated or incorrectly mixed dialysate, excessive pressure, kinked tubing, chemical exposure, or equipment failure. Stop the pump, clamp lines, do not return blood, save the complete system/samples, remove the machine from service, and obtain emergency assessment/labs per policy.
Pyrogenic reaction/fever and chills: infection is the leading concern, but contaminated water/dialysate can cause a reaction. Stop HD and clamp lines; do not return blood when a reaction is possible. Notify the nurse, obtain cultures and water/dialysate samples as directed, and give ordered treatment.
Choking: recognize inability to speak/cough/breathe, panic, noisy breathing, cyanosis, or clutching the throat. Call for help/911; use trained first-aid response (back blows/modified Heimlich) and do not blindly sweep the mouth—remove an object only when visible.
Dialysis disequilibrium syndrome (DDS): rapid toxin/electrolyte shifts can cause headache, nausea, confusion, restlessness, tremor, hypertension, seizure, coma, or death, especially with very high BUN, a new start, neurologic disease, or missed treatments. Reduce clearance with prescribed smaller/shorter/slower treatments and report symptoms immediately.

Why answers are correct

The first priorities are patient safety, stopping the source of harm, calling for trained help, and preserving evidence when contamination or equipment failure is suspected.
Blood return is not automatically beneficial: in air embolism, hemolysis, and possible severe allergic/pyrogenic reactions, returning contaminated or affected blood can worsen harm.

Limitations / traps

Exact clamp/pump/position and medication actions are machine- and facility-specific. A technician should not independently diagnose, prescribe, return blood, or remove needles when the emergency protocol says otherwise.

Clinical pearl / safety

Call for help early, assess the patient, stop the unsafe process, and tell the nurse exactly what was observed and when.

Exam cue

Air: clamp/stop/position; allergy or reaction: do not return blood without direction; hemolysis: stop, clamp, save system, no return.

Medical complications during treatment

Study guide

Arrhythmias: may reflect potassium/calcium shifts, excessive UF, low blood pressure, ischemia, or fluid imbalance. Report irregular rhythm or changing vital signs, minimize UF only under direction, provide oxygen/support, and prepare AED/emergency response.
Chest pain/angina/MI: dialysis patients have high cardiovascular risk. Report promptly; support oxygen and ordered therapy, minimize UF, and stop/return blood only if directed or the patient worsens. Call emergency services for severe or persistent symptoms.
Intradialytic hypotension: often follows excessive/rapid fluid removal, dehydration, a meal, bleeding, infection, cardiac disease, or a low target weight. Keep the patient safe, reduce/stop UF per order, position as directed, give ordered saline/oxygen, recheck BP, and escalate. Prevent with accurate weights, realistic UF goals, and trend review.
Intradialytic hypertension: rising BP can occur despite completing a fluid goal and may reflect inaccurate target weight, medication timing, sympathetic/vascular changes, or chronic cardiovascular disease. Report trends; the nurse/provider reviews weight, medications, sodium, and prescription rather than treating numbers independently.
Hypoxia/hypoxemia: low oxygen may arise from lung disease, heart failure, fluid overload, pulmonary embolism, choking, or poor perfusion. Check pulse oximetry/vitals, give oxygen only as ordered/within scope, support BP and positioning, and escalate severe or unexplained findings.
Seizures: protect the patient from injury, turn to the side, protect access and needles, call for help, monitor vitals, and stop treatment only as directed. Causes include hypotension, hypoxia, electrolyte/glucose shifts, DDS, missed treatments, or head injury.
Sudden cardiac arrest/death: this is a medical emergency. Call for help/911, begin CPR and use the AED per training, stop treatment, and follow the policy for returning blood and needle management. Do not remove needles unless directed.
Pericarditis/pericardial effusion: chest pain, shortness of breath, hypoxemia, fever, hypotension, or heart-failure signs need urgent escalation; fluid around the heart can cause tamponade.
Nausea/vomiting, headache, cramps: assess BP, fluid/electrolyte shifts, UF, DDS, medication effects, and other causes. Keep the patient safe, reduce UF and give saline/medication only per order, protect from aspiration, and report persistent or severe symptoms.

Why answers are correct

“Common” symptoms can be early signs of a lethal event. The technician’s value is rapid observation, accurate reporting, safe basic support, and escalation—not independent treatment changes.

Limitations / traps

Never normalize chest pain, dyspnea, severe headache, altered mental status, or a new rhythm. Do not increase/decrease UF, change dialysate, or give medication from memory.

Clinical pearl / safety

Trend changes matter: compare current BP, pulse, oxygenation, symptoms, and UF progress with baseline and recent treatments.

Exam cue

Patient first: observe, call, support, and follow standing orders; do not improvise machine or medication changes.

Long-term complications

Study guide

Dialysis-related amyloidosis: long exposure to dialysis can allow beta-2 microglobulin deposits in joints/bone, causing shoulder pain, carpal tunnel symptoms, trigger finger, fractures, or spinal/GI involvement. Report pain; the team may evaluate with imaging/biopsy and adjust dialysis or consider transplant.
Calciphylaxis: calcium-related small-vessel blockage causes intensely painful skin nodules/plaques that can become dark, open, infected, and difficult to heal. Risk rises with mineral imbalance, obesity, long dialysis duration, trauma, and some medications. Report pain or lesions before ulcers appear; wound/dermatology care and ordered treatments are urgent.
Vascular calcification: calcium deposits stiffen vessels and valves, restrict blood flow, and increase cardiovascular/limb ischemia risk. Prevention centers on phosphate, calcium, and PTH control, BP/lipid care, smoking cessation, and prescribed treatment.
Muscle cramps: commonly involve legs, feet, or hands and are associated with excessive UF, dehydration, or rapid chemistry changes. Reduce UF and protect the patient; saline, massage, or a higher target weight are nurse-directed options.
Pruritus: itching is common and may be uremic, mineral-related, allergy-related, or due to dry skin/other disease. Prevent skin injury with gentle skin care and short nails; report infection, wounds, or uncontrolled symptoms. Do not scratch open skin.
Restless legs: uncomfortable crawling/aching sensations and an urge to move can disrupt sleep and lead to early treatment termination. Report the impact; the team may review iron, mineral, medication, neuropathy, and exercise/stretching factors.

Why answers are correct

Long-term symptoms affect adherence, sleep, mobility, infection risk, and quality of life. Early reporting can prevent a small lesion or discomfort from becoming a treatment-threatening complication.

Limitations / traps

Do not dismiss severe pain, discoloration, wounds, or new neurologic symptoms as “just dialysis.” Do not recommend supplements or medication changes without the care team.

Clinical pearl / safety

Ask open questions: “What changed?” and “Where does it hurt or itch?” Patients may underreport symptoms until specifically invited.

Exam cue

Report early skin, joint, pain, and sleep changes; prevention depends on accurate weights, UF, mineral control, and adherence.

Root Cause Analysis (RCA) and safety culture

Study guide

RCA is a structured review after a major complication, medical error, or near miss. The team asks what happened and why, then searches for immediate, contributing, and system-level causes—not just the person nearest the event.
Include all relevant levels of staff and examine workflow, equipment, training, communication, staffing, policies, environment, and patient factors. Identify corrective actions that make recurrence less likely.
Share findings with clinic leadership so procedures can be changed, and build a culture in which staff report hazards and near misses without fear of retaliation. Reporting is a safety intervention, not blame.

Why answers are correct

Most adverse events have multiple causes. Fixing only one individual’s mistake leaves the unsafe system in place.

Limitations / traps

RCA is not a substitute for immediate emergency care, documentation, incident reporting, or disclosure through the approved chain. Do not alter evidence or speculate in the chart.

Clinical pearl / safety

Technicians are often first to notice subtle changes. Report abnormal findings and near misses promptly; psychological safety improves patient safety and reduces burnout.

Exam cue

Ask “why” beyond the final error: find system causes, change practice, and verify the change works.

Vocabulary

Uncommon words from this chapter. Plain definitions + a short dialysis-related example.

pathogen: A germ that can cause infection.; Example. Cleaning removes soil; disinfection reduces pathogens on an already-clean surface.
susceptible: Not protected and therefore able to catch the infection.; Example. Staff caring for an HBsAg-positive patient should not also care for susceptible patients when policy forbids it.
cohort: Grouping people with the same infection to limit spread.; Example. During an outbreak, the clinic may cohort patients with the same suspected organism.
prophylaxis: Treatment given to prevent infection or disease after a risk.; Example. Report a needlestick at once so post-exposure prophylaxis can start if indicated.
aseptic: Keeping a sterile medicine or connection pathway free of germs.; Example. Injectable medicines require aseptic technique; a clean-looking vial is not enough.
biohazard: Material that can spread infection, such as blood-soaked tubing.; Example. Blood-contaminated items go in the labeled biohazard stream, not regular trash.
embolism: A bubble or clot blocking a blood vessel.; Example. An air embolism can cause chest symptoms, cyanosis, or collapse.
anaphylaxis: A severe, fast allergic reaction that can close the airway or drop blood pressure.; Example. Anaphylaxis to a dialyzer or medicine is an emergency; do not return blood unless directed.
angioedema: Sudden deep swelling of face, lips, tongue, or airway.; Example. Angioedema with wheeze or hypotension is a severe allergic warning.
exsanguination: Life-threatening blood loss.; Example. A dislodged needle can cause exsanguination within minutes if the access is hidden.
hemolysis: Rupture of red blood cells.; Example. Overheated or wrongly mixed dialysate can cause hemolysis; do not return that blood.
pyrogenic: Caused by fever-triggering contamination, often bacterial products in water or dialysate.; Example. A pyrogenic reaction can look like infection; stop treatment and save samples as directed.
arrhythmia: An irregular or dangerous heart rhythm.; Example. Potassium shifts or too much UF can trigger an arrhythmia.
intradialytic: Happening during the treatment.; Example. Intradialytic hypotension often follows rapid fluid removal.
hypoxia: Not enough oxygen reaching tissues.; Example. Unexplained hypoxia needs escalation; give oxygen only as ordered and within scope.
tamponade: Pressure from fluid around the heart that keeps it from filling.; Example. Pericardial effusion can progress to tamponade and is urgent.
amyloidosis: Long-term deposit of beta-2 microglobulin in joints and bone.; Example. Dialysis-related amyloidosis can cause shoulder pain or carpal-tunnel symptoms.
calciphylaxis: Painful calcium-related skin and vessel injury that can ulcerate and infect.; Example. Report painful nodules before ulcers appear; calciphylaxis needs urgent wound care.
pruritus: Itching.; Example. Severe pruritus can break skin and raise infection risk.
RCA: Root cause analysis: a structured look at why an event happened, including system causes.; Example. RCA is not blame; it asks what in the workflow allowed the error.
nonpunitive: Focused on fixing systems rather than punishing the nearest person.; Example. A nonpunitive safety culture makes near-miss reporting more likely.

Must-know

Standard precautions apply to every patient; hand hygiene remains necessary before and after gloves.
HBV-positive patients require isolation, dedicated equipment, and appropriately immune staff; HIV does not by itself require a dedicated machine.
Use aseptic technique for injections; never use an unlabeled medicine or reuse single-dose vials, syringes, or tubing.
Sharps: safety device on, no hand recapping/bending/breaking, immediate approved disposal, never overfill the container.
Suspected air embolism: call for help, clamp/stop the blood path, position/support per policy, and treat as an emergency.
Suspected hemolysis or pyrogenic/allergic reaction: stop and clamp; do not return blood unless the authorized protocol directs it; preserve system/samples when contamination is possible.
Bleeding or exsanguination: stop pump, apply direct pressure, call for help, keep access visible, and follow emergency policy.
Hypotension: patient safety, reduce UF only as ordered, position/support, saline/oxygen per policy, and reassess.
Chest pain, dyspnea, altered mental status, seizure, or new arrhythmia is never “routine.” Escalate immediately.
Long-term red flags include severe painful skin lesions, nonhealing wounds, new access-area infection, joint/shoulder pain, uncontrolled itching, and symptoms that threaten treatment adherence.
RCA looks for multiple contributing and system causes and supports a nonpunitive culture of safety.

Scope note

This guide is educational and does not replace state law, the nephrologist’s prescription, RN direction, manufacturer instructions, emergency policy, infection-control policy, or hands-on competency validation.