Date of Award


Document Type

Scholarly Project

Degree Name

Doctor of Nursing Practice (DNP)



First Advisor

Dr. Kathleen Farrell, DNSc, RN

Second Advisor

Dr. Staci Harrison, DNP, RN


Practice Problem: Kidney failure affects 0.1% - 0.2% of the general population, yet the dialysis expenditure is 5%-7% of total healthcare budget spending. The increased incidence of chronic disease will result in more End Stage Renal Disease patients on dialysis along with more comorbidities. Thus, it is imperative for health organizations to have well established protocols and guidelines to manage the care of the dialysis patient.

PICOT: The PICOT question that guided this project was: in patients receiving dialysis at an acute care dialysis unit (P), does utilizing a Standardized Policy for Quality Reporting on Dialysis Water Testing and Dialysis Machine Disinfection (I) compared to no policy (C) affect infection rates within eight weeks?

Evidence: The evidence supported the need to optimize microbiological surveillance procedures, test pure water to ensure infection prevention practices, and ensure water safety protocols with monitoring and testing.

Intervention: Collaboration with the organization’s dialysis peer group, regional lab, infection prevention, and dialysis educator helped to develop a regional standardized policy, as well as build the water testing standards into the regional lab’s information technology platform.

Outcome: A regional standardized policy based on the Centers for Medicare & Medicaid Services (CMS) and Association for the Advancement of Medical Instrumentation (AAMI) standards was developed and integrated into the regional lab’s information technology platform in efforts to ensure quality of care and safety. The project positively impacted clinical practice and improved infection rates, in which staff were compliant and competent after being trained.

Conclusion: It is important to have strategies to reduce the risk of infection associated with dialysis; therefore, the project emphasized the importance of having a standardized policy to mitigate infections and ensure both quality of care and patient safety.


Scholarly project submitted to the University of St. Augustine for Health Sciences in partial fulfillment of the requirements for the degree of Doctor of Nursing Practice.

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This work is licensed under a Creative Commons Attribution 4.0 License.