Guidelines, Recommendations and Resources

Nurses, medical providers, technicians and others who work in dialysis facilities face a difficult task of managing the complex conditions affecting their patients while simultaneously focusing on reducing the risk of infection for these at-risk individuals. The resources on this page include guidance documents and web links to resources on the prevention of infection in the dialysis setting.

CDC Guidelines and Recommendations

The guidelines and recommendations included in this section reflect existing evidence-based guidelines produced by the Centers for Disease Control and Prevention and the Healthcare Infection Control Practices Advisory Committee.

2001 CDC Hemodialysis Recommendations

2016 Update to the 2001 CDC Hemodialysis Recommendations

The 2016 update reviews the current recommendations on infection prevention and control for dialysis. Table 1 provides links to current recommendations for specific topics from the 2001 document. Table 2 identifies topics not included in the 2001 document and provides the most recent CDC recommendations on the topic.

Centers for Disease Control and Prevention 2016 Update to the 2001 Recommendations for Preventing Transmission of Infections in Chronic Hemodialysis Patients

This document, Centers for Disease Control and Prevention 2016 Update to the 2001 Recommendations for Preventing Transmission of Infections among Chronic Hemodialysis Patients updates selected information and recommendations in the 2001 Guideline, Recommendations for Preventing Transmission of Infections among Chronic Hemodialysis Patients. This 2016 update provides new references/links for information, updated recommendations (Table 1), and pertinent CDC recommendations that were not addressed in the 2001 Guideline (Table 2).
Some information and recommendations in the 2001 Guideline have been superseded by information that has led to more recent CDC recommendations. These topics include, but are not limited to:

Testing for hepatitis C virus (HCV) infection
Testing for human immunodeficiency virus (HIV) infection
Standard precautions in healthcare settings

Online 2001 version (MMWR)
Printable 2001 version (MMWR) with page numbers [PDF – 386 KB]

Table 1: Information and recommendations in the 2001 Guideline that have been superseded by later CDC information and recommendations, by topic
(Old Content) Infection Control Topics for Dialysis Settings (sections and page numbers refer to 2001 Guideline pdf)	(Updated content) Most Recent CDC Recommendations on Topic
Topic: Laboratory testing for hepatitis C virus (HCV) infection Sections: – Screening and Diagnostic Tests (p. 11) – Routine Serological Testing (p. 24)	Topic: Testing for HCV infection Recommendations (MMWR 2013): Testing for HCV Infection: An Update of Guidance for Clinicians and Laboratorians [PDF – 256 KB]
Topic: Laboratory testing for human immunodeficiency virus (HIV) infection Section: – Human Immunodeficiency Virus Infection (p. 12)	Topic: Laboratory testing for the diagnosis of HIV infection Recommendations (CDC/NCHHSTP 2014): Laboratory Testing for the Diagnosis of HIV Infection – Updated Recommendations
Topic: Indications for HIV testing in patients Section: – Prevention and Management of HIV infection (p. 29)	Topic: HIV testing of patients in healthcare settings Recommendations (MMWR 2006): Revised Recommendations for HIV Testing of Adults, Adolescents, and Pregnant Women in Health-Care Settings
Topic: Cleaning and disinfection of equipment and environmental surfaces Sections: – Equipment, Supplies, and Environmental Surfaces (p. 15) – Cleaning and Disinfection (p. 22)	Topic: Cleaning and disinfection of equipment and environmental surfaces in all healthcare facilities Recommendations (HICPAC 2008): Guideline for Disinfection and Sterilization in Healthcare Facilities, 2008 [PDF – 948 KB]
Topic: Standard precautions to prevent transmission of infectious agents Sections: – Infection Control Precautions for Outpatient Hemodialysis Settings Compared with Inpatient Hospital Settings (p. 17) – Infection Control Precautions for all Patients (p. 19) – Cleaning and Disinfection (p. 22)	Topic: Standard precautions to prevent transmission of infectious agents in all healthcare settings Recommendations (HICPAC 2007): 2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings [PDF – 1.9 MB]

CDC recommendations and information issued after 2001 address some topics not included in the 2001 Guideline. These topics include, but are not limited to:

Preventing hemodialysis catheter-related infections
Screening patients for latent tuberculosis infection
Recommended vaccinations for some vaccine-preventable diseases

Table 2: Topics not addressed in the 2001 Guideline that have been addressed by other CDC recommendations and information issued after 2001
Topic	Most Recent CDC Recommendations on Topic
Preventing hemodialysis catheter-related infections	Topic: Prevention of intravascular catheter-related infections Recommendations (HICPAC 2011): Guidelines for the Prevention of Intravascular Catheter-Related Infections, 2011 [PDF – 1 MB]
Screening patients for latent tuberculosis infection	Topic: Screening for latent tuberculosis infection Recommendations (MMWR 2000): Targeted Tuberculin Testing and Treatment of Latent Tuberculosis Infection Recommendations (MMWR 2010): Updated Guidelines for Using Interferon Gamma Release Assays to Detect Mycobacterium tuberculosis Infection – United States, 2010
Recommendations for vaccinations to prevent viral and bacterial infections in patients and healthcare personnel	Topic: Vaccination and immunization for patients and healthcare personnel Recommendations (ACIP 2016): ACIP Vaccine Recommendations

Infection Control Requirements for Dialysis Facilities and Clarification Regarding Guidance on Parenteral Medication Vials (2008)

2012 Vaccination Guideline for Dialysis and CKD Patients

Guidelines for Vaccinating Kidney Dialysis Patients and Patients with Chronic Kidney Disease (ACIP)pdf icon [PDF – 12 pages] (2012)

Additional CDC Guidelines

Readers are urged to consult the full guidelines for background, rationale, and evidence behind each recommendation. All guidelines are available at: Guidelines and Recommendations

Clinical Practice Consensus Guidelines

Additional Resources

Centers for Medicare & Medicaid Services

The Centers for Medicare & Medicaid Services (CMS) Survey and Certification Program certifies ESRD facilities for inclusion in the Medicare Program by validating that the care and services of each facility meet specified safety and quality standards, called “Conditions for Coverage.” The CMS Dialysis page provides basic information related to survey and certification of dialysis facilities for ESRD surveyors and dialysis providers. It includes links to applicable laws and regulations and provides resources to support and assess compliance with Federal regulations.