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Accréditation Sans Frontières · ASF Health Standards 9.0

Standard 22 · Dialysis and Renal Replacement

12 criteria · optional module (declare to apply)

Optional module (declare to apply). 12 criteria, of which 8 non-negotiable. Each criterion is numbered 22.Y, with its classification and verification questions.

Criteria

22.1 Dialysis Water Is Treated and Tested to a Documented Standard

NON-NEGOTIABLE

Water used to prepare dialysis fluid and to reprocess dialysers meets documented chemical and microbiological requirements, is tested on a defined schedule, and every result is reviewed and acted on.

VERIFICATION QUESTIONS

  1. Is the water used for dialysis tested for chemical and microbiological quality on a defined schedule, with the results recorded?
    A result that is filed but not acted on gives no protection.
  2. Does each out-of-range result trigger a documented corrective action and a retest?
    Continued treatment on water that failed a test is a known hazard.
  3. Is the water quality standard the one set in ISO 23500-3 (water for haemodialysis), or a documented equivalent?
    The standard used must be named, so that the test can be checked against it.

22.2 Water Treatment Equipment Is Maintained and Monitored Online

NON-NEGOTIABLE

Water treatment equipment, including its online conductivity monitoring and distribution piping, is maintained on a schedule, and its readings are monitored during every session.

VERIFICATION QUESTIONS

  1. Is water treatment equipment maintained on a defined schedule, with the work recorded?
    Filters and membranes that are not replaced on time allow contamination through.
  2. Are online monitors checked and calibrated on a schedule, and are alarms tested?
    A monitor that has drifted gives a reassuring reading that is wrong.
  3. Are distribution pipes and storage tanks inspected and disinfected on a schedule?
    Biofilm in pipes is a source of infection.

22.3 Dialysis Fluid and Concentrates Are Prepared to a Documented Procedure

NON-NEGOTIABLE

Concentrates are prepared, and dialysis fluid is mixed, to a written procedure that is followed for every batch, with each batch identified and traceable to its preparation.

VERIFICATION QUESTIONS

  1. Is each batch of concentrate or dialysis fluid prepared to a written procedure, and is the procedure followed?
    Preparation errors change the composition of the fluid the patient receives.
  2. Is each batch labelled and traceable to the person who prepared it and the date?
    A batch that cannot be traced cannot be recalled.
  3. Are concentrates stored and used within their stated shelf life?
    Expired concentrate may no longer have its stated composition.

22.4 Dialysers Are Reprocessed Safely, Traced, and Used Only Where Permitted

NON-NEGOTIABLE

Dialysers are reused only where they are marked for reuse and only after reprocessing to a validated procedure, and each dialyser is traceable to its patient and its reprocessing cycles.

VERIFICATION QUESTIONS

  1. Is each dialyser reused only where it is marked for reuse, and is single-use equipment never reprocessed?
    Reusing single-use equipment is a direct route for infection.
  2. Is reprocessing carried out to a validated procedure, with each cycle recorded?
    A cycle that cannot be shown on record cannot be shown to have been done.
  3. Can each dialyser be traced to the patient who used it and to its reprocessing history?
    Traceability is how an infection cluster is traced to its source.

22.5 Each Treatment Is Prescribed, and Its Adequacy Is Monitored

CORE

Each patient has a written dialysis prescription, the adequacy of each treatment is measured against the target set by the treating clinician, and changes in the prescription are recorded.

VERIFICATION QUESTIONS

  1. Does every patient have a written dialysis prescription, reviewed on a defined schedule?
    A prescription that is never reviewed does not match the patient's condition.
  2. Is treatment adequacy measured on a defined schedule, against the targets of the National Kidney Foundation KDOQI Clinical Practice Guideline for Hemodialysis Adequacy (2015 update), including a target single-pool Kt/V of 1.4 per session with a minimum delivered spKt/V of 1.2 for thrice-weekly treatment?
    Adequacy must be measured, not assumed from the duration of the session.
  3. Are changes to the prescription recorded with the reason for the change?
    An unexplained change cannot be reviewed.

22.6 Vascular Access Is Assessed, Protected and Its Infections Tracked

NON-NEGOTIABLE

Each patient's vascular access is assessed at each session, cared for to a written protocol, and any access-related infection is recorded and reviewed.

VERIFICATION QUESTIONS

  1. Is each patient's vascular access assessed at each session?
    An access problem missed in one session can cause an emergency in the next.
  2. Is access care carried out to a written protocol, including catheter care and dressing changes?
    Catheter-related bloodstream infection is a well-recognised, preventable harm in dialysis.
  3. Are access-related infections recorded, reviewed, and used to change practice?
    A rate that is not tracked cannot fall.

22.7 Dialysis Machines Are Checked Before Each Session

NON-NEGOTIABLE

Each machine is checked before use against a written checklist, and any fault is recorded and the machine is withdrawn until repaired.

VERIFICATION QUESTIONS

  1. Is each machine checked before each session against a written checklist?
    A check done once a week does not protect the patient on the day it fails.
  2. Are faults recorded, and is a faulty machine withdrawn from use until it is repaired?
    A machine that is used despite a known fault is a known risk.
  3. Are machines serviced on a defined schedule, with the service recorded?
    Scheduled service can prevent faults that a daily check cannot detect.

22.8 Emergency Response During Dialysis Is Ready

NON-NEGOTIABLE

Staff are trained and equipped to respond to the emergencies that occur during dialysis, including low blood pressure, air in the blood line, allergic reactions and cardiac arrest, and the response is rehearsed.

VERIFICATION QUESTIONS

  1. Are staff trained to recognise and respond to the emergencies that occur during dialysis?
    Many dialysis emergencies are predictable, so staff can be trained for them.
  2. Is emergency equipment, including oxygen and resuscitation equipment, checked and immediately available in the dialysis area?
    Equipment that must be fetched costs time the patient may not have.
  3. Are emergency responses rehearsed on a defined schedule, with the rehearsal recorded?
    A response that has never been rehearsed is untested.

22.9 Infection Prevention Across the Dialysis Unit

NON-NEGOTIABLE

Hand hygiene, isolation of infectious patients and cleaning of shared dialysis equipment and surfaces follow written procedures, and compliance is monitored.

VERIFICATION QUESTIONS

  1. Is hand hygiene practised at each point of care, and is compliance monitored?
    Dialysis involves repeated contact with patients' blood-carrying equipment.
  2. Are patients with known infections isolated or treated in a separate sequence, as the procedure requires?
    Shared machines carry infection from one patient to the next without isolation.
  3. Are shared surfaces and equipment cleaned and disinfected between patients, with the procedure followed?
    A machine that is not cleaned between patients transfers what the last patient carried.

22.10 Patients Are Informed About Their Dialysis Choices

CORE

Patients receive information about treatment options, including home and other modalities where they exist, and their decisions are recorded.

VERIFICATION QUESTIONS

  1. Are patients told about the treatment options available to them, including home dialysis where it exists?
    A patient who is not told of a choice cannot make it.
  2. Is each decision about treatment recorded, with the information the patient was given?
    A decision without a record of what the patient understood cannot be defended.
  3. Is the patient's decision reviewed when their condition changes?
    A choice made at diagnosis may no longer suit the patient later.

22.11 Staffing and Competence for Dialysis Are Defined

CORE

Dialysis staffing levels, roles and competence requirements are defined, and each member of staff is competent for their role before working unsupervised.

VERIFICATION QUESTIONS

  1. Are staffing levels and skill mix for dialysis defined and monitored?
    A dialysis session needs trained staff present throughout.
  2. Is each member of staff assessed as competent for their dialysis role before working unsupervised?
    Competence is shown by assessment, not by length of service.
  3. Is competence refreshed on a defined schedule?
    Dialysis techniques and equipment change, and competence must keep pace.

22.12 Dialysis Outcomes and Incidents Are Reviewed

CORE

Dialysis incidents and outcome measures are recorded, reviewed on a defined schedule, and acted on, and serious incidents are investigated under the facility's incident process.

VERIFICATION QUESTIONS

  1. Are dialysis incidents recorded and reviewed on a defined schedule?
    Incidents that are not reviewed do not change practice.
  2. Are outcome measures for the dialysis service recorded and reviewed?
    A service that does not measure its outcomes cannot show that it works.
  3. Are serious dialysis incidents investigated under the facility's incident process, with changes recorded?
    The learning from one serious incident should reach every unit. ————————————————————

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