Hemodialysis Boxes - Maintenance Requirements

What are the maintenance requirements for hemodialysis plumbing fixtures in patient rooms?

Any examples are for illustrative purposes only. 
 
Plumbing fixtures such as a recessed box, combine the water supply and drain in patient rooms for use with hemodialysis equipment.  Typically, these fixtures are connected to your regular water supply and then connected to the dialysis machine through a portable reverse osmosis (RO) system. This fixture is essentially a faucet with a dead leg.  The risk of not periodically flushing this fixture could result in stagnate water. 
 
Wall boxes need to be cleaned, disinfected, and properly maintained to decrease risk of patient infections.  They can become easily contaminated with microorganisms, which can subsequently be transferred to dialysis patients, a vulnerable group at high risk of infection. 
 
These water box fixtures are utility components and as such should be included in your utilities maintenance program and maintained in accordance with manufacturer requirements; see EC 02.05.05 EP 6 and are included in the water management plan required by EC.02.05.01 EP 14.  
 
The Joint Commission encourages organizations with these types of water fixtures follow the CDC guidelines that include: 
  • Each facility should develop policies about the specific frequency and methods for wall box surface disinfection 
  • Wall box surfaces should be disinfected at least daily 
  • Cleaning and disinfection of the wall box should be performed after the patient has left the station 
  • Disinfectant should be applied to all surfaces of the wall box and any attached hoses 
  • Ensure high touch surfaces (e.g., connections for acid, bicarbonate, and reverse osmosis water) are disinfected 
  • Wipes or other supplies used to disinfect the wall box should be discarded after use and not used to disinfect other surfaces in the dialysis station 
  • More than one disinfectant wipe or application may be needed to ensure all wall box surfaces are visibly wet with disinfectant to achieve contact time specified by the manufacturer 
Additional Resources: 
CDC Guidelines Dialysis Wall Boxes and Drains 
Last updated on August 11, 2020
Manual: Ambulatory
Chapter: Environment of Care EC

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