Setting up of Hemodialysis Unit

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Setting up of maintenance hemodialysis (MHD) unit is a major challenge for an uninitiated nephrologist. The purpose of this guideline is to help design a new unit.

Dialysis (Hemodialysis) Area

We recommend that the hemodialysis (HD) treatment area (dialysis machine + bed or chair) should have the following features:

The dialysis area specifications and requirements shall include enough space to accommodate the number of provided dialysis stations.

The dialysis area should be air conditioned so as to achieve 70°F–72°F temperatures and 55%–60% humidity

Each machine should be at the center of sufficient area [ Figure 1 ] to allow easy movement of personnel and resuscitation equipment whenever needed. The layout should have facilities for protecting patient's privacy

Typical hemodialysis machine area. Black dots: electricity outlets, green dots: oxygen outlet, yellow dots: vacuum outlet, blue dots: treated water inlet, ash dot: drainage outlet

Nursing station (counter): This requires an unobtrusive view of all patient treatment areas. The nursing station should also be within the range of hearing alarms from the machines for taking appropriate timely actions. The nursing station should have enough space for on-duty nurses/working technicians, a computer terminal, and a working desk/bench. There should be a cupboard/space to store emergency medicines/disposables

Floor covering in the dialysis area shall be monolithic and joint free. The floor occupied by each dialysis station shall be large enough to accommodate the dialysis chair/couch, dialysis machine, as well as working room for two dialysis personnel. There should be adequate clearance space between the dialysis stations

The head end of each bed should have stable electrical supply with at least six sockets of 5/15 A, oxygen and vacuum outlet, treated water inlet, and drainage. The wires from the electric sockets should be in such a way that they do not pose a threat to the patient or staff during the dialysis. The minimum door-opening width (desirable – 1.12 m) should be sufficient for easy transport of patient on trolleys/wheelchair to the dialysis station. The minimum ceiling height shall be 2.4–2.7 m

Isolation room: There should be separate areas for dialyzing patients with conditions that require isolation (desirable) to ensure safety to patients and staff in the dialysis room. This area should have independent water supply and drainage facilities. Facilities that dialyze patients with known blood-borne pathogens shall have at least two separate rooms to use for those patients as follows:

This should not be considered a substitute for universal precautions observed in the dialysis facility

Facilities for handwashing and alcohol-based hand rub/ sterilant dispensers should be available in all patient areas and should be easily accessible. Hand-washing basins (an area of the basin 1 m 2 ) usually made of porcelain, stainless steel (SS), or solid surface materials should also be available in the facility

The dialysis room should contain additional equipment that is required for regular use in the unit such as a weighing scale and stadiometer, cardiac monitors, defibrillator, and infusion pumps

All surfaces and fixtures are to be designed to enable easy and thorough cleaning on a regular and repeated basis to ensure a high level of infection control in all aspects of practice. High levels of cleaning are to be conducted in the unit daily. All surfaces should be free from seams and creases which may harbor bacteria. Vinyl that requires a warm water wash and does not require daily polishing should be included in all treatment areas.

Floors: This must be covered by ceramic or flooring surfaces which may be chosen in such a way that it is easy to maintain, is readily cleanable, and is resistant to disinfection procedures. Epoxy flooring is desirable

Skirting should be covered to prevent dirt congregating in corners. It should extend all the way up the wall up to 20 cm or up to 30 cm (desirable) to protect all potentially wet areas from infiltration

Ceilings: All exposed ceilings and ceiling structures must be easy to clean. All areas where dust fallout would present a potential problem must have finished ceilings that cover all conduits and pipes

Window furnishings: Washable blinds are preferable to curtains as they retain less dust and are easier to clean and nonflammable. Washable paint should be applied for all walls and ceilings

Natural light contributes to a sense of well-being, assists orientation to building locations, and improves service outcomes. The use of natural light should be maximized throughout the unit.

Dialyzer Reprocessing Area

We recommend an independent area for reprocessing the dialyzers. This should have a workbench and a sink with a sideboard and drainage. The workbench should have separately marked treated as well as untreated water supplies at a water line pressure of 1.3 kg/cm 2 (20 psi). There should be two sinks (one for initial cleaning and the other for filling sterilent, packing, and labeling) of the dialyzer. We suggest that the space should be sufficient for two persons working simultaneously.

We recommend the use of sinks with a depth of at least 45 cm with a drainage mesh at a depth of around 20 cm to prevent the dialyzer and tubing resting in the effluent

We recommend that the washing area be equipped with two outlets or a “T” connection. Two different fittings should be provided on the water line at each reprocessing area, a standard tubing to clean the blood compartment, and a Hansen connector for backwashing the dialysate compartment

We recommend a physically separate reprocessing area for processing dialyzers of patients with HCV infection

Drainage System

Services that facilitate the drainage of waste fluids from the HD machines must be ventilated to prevent condensation and the subsequent growth of mold. This fact should be kept in mind when designing covers or screens for the drainage systems. Drainage systems should be constructed of a chemically resistant material such as high-density polyethylene. The dialysate and the reprocessing effluent should drain into a separate drainage system/tank with adequate capacity to handle the volume.

We recommend that the number of bends in pipelines be kept to a minimum and blind loops be avoided.

We recommend that all drainage systems should be connected directly to the main drainage line in a straight line without bends or blind loops [Figures ​ [Figures2a, 2a , ​ ,2b, 2b , ​ ,3 3 and ​ and4 4 ].

Spout with appropriate elevation and gradient