Beyond the Basics: Advanced Dialysis Equipment Needs Smart Care

Executive Summary / Key Takeaways

Key Takeaways:

• Advanced dialysis equipment requires specialized cleaning and disinfection to ensure patient safety and device longevity.

• Generic or harsh disinfectants can damage sensitive components, leading to malfunctions and increased costs.

• Always follow the latest manufacturer Instructions for Use (IFUs) and educate both staff and home patients on proper cleaning protocols.

• Ongoing staff training and regular protocol reviews are essential for maintaining high standards of care.

Every nurse knows that attention to detail can make all the difference in patient care. The same principle applies to how we disinfect and maintain our dialysis equipment, especially as technology evolves.

Chronic kidney disease (CKD) affects over 37 million Americans, and more than 500,000 rely on dialysis to survive. (Centers for Disease Control and Prevention [CDC], 2023; United States Renal Data System [USRDS], 2023). As dialysis technology advances, the machines we use have become more sophisticated—and more sensitive to improper disinfection.

A Lesson from the Driveway: The Cost of "Quick Fix" Cleaning

For her 50th birthday, my mother-in-law received her dream car: a Mercedes S550, loaded with every advanced feature. She reserved it for special occasions, and during family visits I took pride in detailing it, especially after harsh Ohio winters. I quickly learned that quick car washes with harsh chemicals could damage the car's finish and sensitive features. The lesson? Smart care means using the right solutions, not just more effort.

Now, I'd be the first to say that comparing a car to the medical devices essential to the lives of those battling dialysis-related illness might seem insensitive. But hear me out. You're right—cleaning a car, in any setting, with any product, is not the same as the work of a team of professionals—biomeds, certified dialysis technicians, nurses, doctors—managing the complexities of patient care. However, the simplicity of "smart care," using the right products in the right way, is what allows both cars and dialysis equipment to function reliably, safely, and for as long as possible. Just as cars have evolved, so too has dialysis technology, bringing new benefits and new challenges.

The Evolution of Dialysis Technology

• Touchscreens: Intuitive operation interfaces that allow for easier control and monitoring.

• Sensitive Sensors: Real-time monitoring capabilities that enhance patient safety and treatment efficacy.

• Network Connectivity: Data integration and remote troubleshooting cp,capabilities that improve care coordination.

Dialysis machines have come a long way from their durable, utilitarian origins. These innovations improve patient care and workflow—and also introduce new vulnerabilities.

With these advancements, it’s important to recognize that not all cleaning methods are created equal, especially when it comes to protecting sensitive equipment.

The Risks of "One-Size-Fits-All" Disinfection—Including Quaternary Ammonium Compounds

QACs, such as benzalkonium chloride and didecyl dimethyl ammonium chloride, are common in hospital-grade disinfectant wipes and sprays. While effective for non-critical surfaces, repeated use of QAC-based products on sensitive equipment, especially touchscreens and control panels—can leave residues that degrade coatings, cloud displays, and interfere with touch sensitivity. (Rutala & Weber, 2016; AAMI, 2021). Over time, this can accelerate wear and lead to costly repairs or replacements.

A frequently overlooked step in many manufacturer’s Instructions for Use (IFUs) is to clean screens and sensitive surfaces with a soft cloth dampened with water—either as the primary cleaning method or as a final step after disinfection. This simple practice helps remove chemical residues left by QACs or other disinfectants, preserving the clarity and function of touchscreens and extending the life of the equipment. Unfortunately, this step is often skipped in busy clinical environments, increasing the risk of cumulative damage. The consequences of improper disinfection can be subtle at first, but over time, they add up—both in terms of equipment performance and patient safety.

The Hidden Cost of "Quick Fix" Disinfection

It's tempting to reach for whatever is fastest or most convenient—like mixing up a bleach solution on the fly or grabbing a generic wipe. But, did you know that using the wrong product or concentration can accelerate the breakdown of sensitive device surfaces? In contrast, using disinfection products in accordance with their IFU—such as individually packaged, manufacturer-approved wipes—delivers the right concentration every time, protecting both the equipment and the people who use it (AAMI, 2021).

It reminds me of running that dream car through a harsh bristle car wash. From a distance, the car might look spotless. But up close, you'd see the fine scratches, the dulling of the finish, and the slow stripping away of protective layers. Before long, rust and decay would set in, turning a prized possession into a mechanic's best friend.

In our dialysis units, the stakes are even higher. More precious than any car are the patients we serve. Our responsibility is to provide a safe environment—one where the "layers of protection" on our equipment are preserved, not stripped away by quick fixes or shortcuts. When we use the right disinfection solutions, in the right way, we're not just maintaining machines, we're safeguarding the health and dignity of every person who depends on them. Understanding the long-term impact of our daily choices leads us to consider how we can better manage and slow equipment degradation.

Degradation: Inevitable, but Manageable

It's important to recognize that some degree of equipment degradation is inevitable over time due to repeated use, exposure to disinfectants, and the mechanical and chemical stresses of daily operation. However, smart care and adherence to best disinfection practices can significantly slow this process, preserving device function and safety for both patients and staff (AAMI, 2021).

By always following manufacturer instructions for use (IFUs), using the correct disinfection products at the right concentrations, and thorough rinsing to remove chemical residues, we can minimize unnecessary wear and chemical damage to sensitive components. This approach not only extends the lifespan of machines but also reduces costly repairs, device downtime, and the risk of infection outbreaks linked to equipment failure or contamination.

For the renal community, this makes a real difference:

• Patients benefit from safer, more reliable treatments and fewer interruptions in care.

• Nurses and staff experience less workflow disruption and greater confidence in their equipment.

• Facilities save on repair and replacement costs, allowing resources to be directed toward patient care and innovation.

As home dialysis becomes more common, these principles are just as important outside the clinic as they are within it.

The Growing Need for Education in Home Dialysis Settings

Yet, in practice, many patients would quietly admit to not mixing bleach in containers as instructed, and some would even decline replenishing their inventory with bleach jugs altogether. So, what were they using? And did I ask? Often, the convenience of container wipes outweighed the perceived hassle of preparing bleach solutions. But what ingredients did those wipes contain? Many included QACs or other chemicals contraindicated for cleaning dialysis equipment, something I only learned later in my role as a product specialist. (AAMI 2021.)

As my Southern mom would say after I'd told her I cleaned the kitchen, "You cleaned, but did you clean clean?" I've grown up translating that as the extra clean—the kind that ensures it's done right.

Nothing was more telling than seeing HHD equipment retrieved from homes, where our Biomed team would witness firsthand the true challenges of equipment disinfection faced by many, despite protocols and preventive maintenance. The uniqueness of every household, the frequency of home visits, and the variety of cleaning product options all pose real challenges for home patients. Are we talking about this enough?

Consider peritoneal dialysis patients performing exchanges using automated PD cyclers. If they disinfect the external components of their device with a harsh chemical or mix chemicals at a strong ratio, over time, they may need to call technical service for device issues. Erring on the side of caution, the device is replaced and delivered the next day. If there's a delay, the on-call nurse may instruct the patient to perform manual exchanges. Although patients are trained and regularly verified through return demonstration, the frequency of ordered backup manual exchanges—regardless of their similarities to CCPD—results in a change. And changes can increase negative opportunities for routines—routines that minimize risk, like peritonitis.

While current data may not definitively link these practices to patient outcomes, further research is crucial to validate this hypothesis. A deeper understanding could lead to enhanced protocols, significantly improving patient safety and quality of life. To help address these challenges, it’s important to dispel common myths and avoid frequent mistakes in equipment cleaning.

Common Myths and Mistakes in Dialysis Equipment Cleaning

• Myth: “All hospital-grade wipes are safe for dialysis machines.”

  • Fact: Many contain chemicals (like QACs) that can damage sensitive components.

• Myth: “If a little disinfectant is good, more is better.”

  • Fact: Over-concentration can accelerate equipment breakdown and void warranties.

• Mistake: Skipping the final water wipe after disinfection.

  • Consequence: Residual chemicals can cloud screens and degrade touch sensitivity.

• Mistake: Using the same cleaning protocol for all devices.

  • Consequence: Each device may have unique requirements—always check the IFU.ca

Real-world experiences further highlight the importance of following best practices.

Case Example: Preventing Device Downtime Through Smart Care

At a busy dialysis center, staff noticed frequent malfunctions in their new touch-screen dialysis machines. Investigation revealed that generic disinfectant wipes were being used, leaving residues that interfered with the screens. After switching to manufacturer-approved wipes and retraining staff on the correct cleaning protocol, device downtime dropped by 80%, and patient treatment delays were significantly reduced. This example underscores the value of staying up to date with manufacturer guidance, which is continually evolving.

The Living Nature of IFUs: Stay Informed

Instructions for Use (IFUs) are living documents that may be updated by manufacturers as new evidence emerges, device materials change, or regulatory and quality standards evolve. Enhancements or changes in IFUs are common and are typically driven by manufacturers' Quality departments, whose goal is to ensure ongoing device safety, effectiveness, and regulatory compliance.³

• IFUs Can Change: Updates may reflect new cleaning agents, revised concentrations, improved procedures, or new warnings based on post-market surveillance.

• Based on Testing: Original IFUs are based on validation testing, including material compatibility, efficacy of disinfection, and simulated use studies.

• Quality Monitoring: Quality departments continually review field data, adverse event reports, and new scientific findings.

• Stay Informed: Subscribe to manufacturer notifications, regularly check websites, and incorporate updates into staff training.

• Standardize Care: Following current IFUs helps standardize care, reduce errors, and ensure staff use the safest methods.

With this in mind, let’s review the best practices for smart, safe disinfection.

Smart Care: Best Practices for Disinfection

• Follow Manufacturer IFUs: Each device has specific recommendations for disinfection agents and methods.

• Use Proper Products: Choose wipes with appropriate concentrations designed for your specific needs.

• Special Care for Electronics: Never spray liquids onto electronics; apply to a cloth first.

• Include Home Equipment: Train patients and caregivers on proper disinfection techniques (AAMI, 2021).

• Staff Training: Regularly review disinfection protocols and conduct competency checks.

• Prevent Biofilm: Proper disinfection prevents biofilm development and reduces infection risk (Rutala & Weber, 2016).

• Monitor IFU Updates: Make it routine to check for and implement the latest manufacturer recommendations.

To make these best practices actionable, here’s a checklist for daily use.

Action Steps for Nurses: Smart Care Checklist

Smart Care Checklist for Dialysis Equipment:

• Review and follow the most current IFUs for each device.

• Use only manufacturer-approved cleaning products and concentrations.

• Never spray disinfectants onto electronic components; always apply to a cloth first.

• After disinfection, wipe sensitive surfaces with a damp, soft cloth to remove chemical residues.

• Train all staff and home patients on proper cleaning and disinfection techniques.

• Routinely check for IFU updates and incorporate changes into staff training.

• Document any device malfunctions or cleaning challenges and report them promptly.

The nurse’s role is central to ensuring these steps are followed and that both patients and equipment are protected.

The Nurse's Role in Device Longevity and Patient Safety

Nurses are the frontline protectors of technology. Practicing smart care and proper disinfection of dialysis equipment is essential for:

• Patient Safety: Reducing infection risk and device-related errors.

• Workflow Efficiency: Minimizing downtime and delays.

• Device Longevity: Protecting the organization's investment.

Continued education and access to reliable resources are key to maintaining these standards.

Resources for Ongoing Education

• AAMI Dialysis Equipment Cleaning and Disinfection Guidelines

• CDC: Dialysis Safety Resources

• Manufacturer training modules (check device manufacturer’s websites for updates)

• In-service training sessions and competency checks for all staff

Conclusion & Call to Action

Just as a luxury car needs more than a quick wash, our advanced dialysis equipment deserves smart, thoughtful care. Let's move beyond the basics: review protocols, share best practices, stay alert for IFU updates, and advocate for device-specific training. Our patients—and our technology—depend on it.

Call to Action:
Take a moment this week to review your unit’s dialysis equipment cleaning protocols. Schedule a staff in-service to discuss the latest IFU updates and best practices. By working together and staying informed, we can ensure the safest, most reliable care for every patient.

Remember: Smart care, using the right products in the right way, allows dialysis equipment to function reliably, safely, and for as long as possible—just like that Mercedes S550.

References

1. Association for the Advancement of Medical Instrumentation (AAMI). (2021). Dialysis Equipment Cleaning and Disinfection.

2. Rutala, W. A., & Weber, D. J. (2016). Disinfection and sterilization in health care facilities: An overview and current issues. Infectious Disease Clinics of North America, 30(3), 609-637.

3. Centers for Disease Control and Prevention. (2023). Chronic Kidney Disease in the United States, 2023. https://www.cdc.gov/kidneydisease/publications-resources/ckd-national-facts.html

4. United States Renal Data System. (2023). USRDS Annual Data Report: Epidemiology of Kidney Disease in the United States. https://usrds-adr.niddk.nih.gov/2023