Infection Control in Canadian Dialysis Units: CSA Z364 and Public Health Requirements
A dialysis unit treats the same patients three times a week on machines shared across a shift, with blood leaving and returning to the body through tubing staff handle constantly. Hepatitis B virus survives at least seven days on environmental surfaces. That combination of repeated patient contact, a resilient virus and shared equipment is why Canadian dialysis programmes answer to a quality management standard and to public health guidance at the same time.
What does the CSA Z364 series cover?
The CSA Z364 family is the Canadian standard set for kidney dialysis, and CSA Z364.6, Quality management for kidney dialysis providers, is the core document in it. It sets out the quality management system a programme needs across its processes and equipment, in a facility or at home, and it is written so a unit is assessed against its own documented system rather than a checklist of equipment. The current edition is the second edition, published in 2023.
Adjacent documents in the family cover defined technical areas, including the reuse of haemodialysers. A programme that reprocesses dialyzers works to that standard; one running single-use dialyzers still answers to the quality management document for training, monitoring and records.
Which public health requirements apply to a dialysis unit?
IPAC Canada's dialysis interest group publishes the practice recommendations that Canadian units work from, and they are specific enough to audit against.
| Requirement | What it says | Where it shows up in a unit |
|---|---|---|
| Machine, external surfaces | cleaned and disinfected with a facility-approved low-level disinfectant before use on another patient | turnover routine between patients, agent recorded per station |
| Machine, internal surfaces | high-level disinfectant before another patient after a hepatitis B surface antigen positive patient | machine disinfection log with cycle and agent |
| Station surfaces | bed or chair, table, doorknobs and remote cleaned and disinfected after treatment | end-of-treatment record |
| Single-use injectables | dedicated to one patient, entered once; multidose vials avoided | medication preparation area away from contaminated surfaces |
| Patient screening | serology including HBsAg, anti-HBs and anti-HBc before admission or at first treatment, then annually | screening register and follow-up for susceptible patients |
| Immunisation | vaccination for susceptible patients and for staff who work with blood | staff immunisation record and anti-HBs result |
What changes for a hepatitis B surface antigen positive patient?
Published guidance puts that patient in a separate room, with a dedicated machine and dedicated equipment, medications and supplies. Where a separate room is not available, a separate area can be used to separate the patients geographically, and staff should not care for hepatitis B positive and susceptible patients at the same time. Dialyzers are not reused on these patients.
The rule that catches units out is the interim one: when a patient's hepatitis B status is unknown at the first treatment, the machine is not used on another patient until both internal and external surfaces have been cleaned and disinfected. A unit that treats an untested patient on a shared machine and moves to the next chair has to show that disinfection happened first.
What does the unit need on the shelf to run this?
The machine side is chemistry. The patient side is consumables: nitrile examination gloves for direct care and for touching the patient's equipment, disposable isolation gowns for procedures that may soil clothing, and face shields where splashes are possible. Waste is separated at the point of care: red infectious waste bags hold blood-contacted waste, in single-use containers labelled for that stream.
Vascular access care has its own published recommendations covering catheter dressing, hub disinfection and the hand hygiene that goes with each exchange.
Ordering for a clinic, lab or care home? Wholesale and multi-site ordering covers account setup and case pricing, and the B2B wholesale collection lists the lines stocked for institutional buyers.
References
- IPAC Canada - Infection prevention and control measures to prevent transmission of hepatitis B among hemodialysis patients (checked 24 September 2026)
- IPAC Canada - Practice recommendations for intravascular dialysis catheter care to prevent central line-associated bloodstream infections in adults (checked 24 September 2026)
- IPAC Canada - Infection control resources: standards and guidelines (checked 24 September 2026)
Related Reading
- Dialysis Clinic Supplies: Consumables for Each Treatment Bay
- Dialysis Units in Canada: Consumables for Vascular Access Care
- Dialysis Center Supplies: Gloves, Wipes and Waste Handling Basics
- sterilization log sheet template
Frequently Asked Questions
What does the CSA Z364 series cover?
It is a family of Canadian standards for kidney dialysis. CSA Z364.6, Quality management for kidney dialysis providers, is the core document: the quality management system a programme needs for its processes and equipment, in a health care or home setting. The current edition is the second edition, published in 2023.
How is a dialysis machine prepared between patients?
External surfaces are cleaned and disinfected with a facility-approved low-level disinfectant before the machine is used on another patient. Where a patient is hepatitis B surface antigen positive, the internal surfaces, or pathways, are disinfected with a high-level disinfectant before the machine goes to another patient.
Which patients need a dedicated machine?
Guidance places hepatitis B surface antigen positive patients in a separate room with a dedicated machine, equipment, medications and supplies. Without a separate room, a separate area separates them geographically from susceptible patients, and staff do not care for both groups at the same time.
What else has to be cleaned after a treatment?
Everything the patient touched in the station: the bed or chair, the table, the doorknobs and the television remote, plus the machine surfaces above. The station record shows the agent used and the time.
Are dialyzers reused in Canadian programmes?
Reprocessing haemodialysers has its own Canadian standard, and programmes that reuse dialyzers follow it. One point is absolute in the hepatitis B guidance: a dialyzer used on a hepatitis B surface antigen positive patient is not reused on anyone.
Last updated: September 2026. CliniEco Medical is a licensed medical device establishment (MDEL #35334).
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