Hostname: page-component-848d4c4894-8kt4b Total loading time: 0 Render date: 2024-06-16T21:53:39.275Z Has data issue: false hasContentIssue false
  • English
  • Français

Clustered Bacteremias in a Hemodialysis Unit Cross-Contaminationof Blood Tubing From Ultrafiltrate Waste

Published online by Cambridge University Press:  21 June 2016

Robert N. Longfield ,
William G. Wortham ,
Linda L. Fletcher  and
William F. Nauscheutz
Robert N. Longfield*
Affiliation:
Infectious Disease Service, Brooke Army Medical Center, Fort Sam Houston, Texas
William G. Wortham
Affiliation:
Nephrology Service, Brooke Army Medical Center, Fort Sam Houston, Texas
Linda L. Fletcher
Affiliation:
Infection Control Service, Brooke Army Medical Center, Fort Sam Houston, Texas
William F. Nauscheutz
Affiliation:
Clinical Microbiology Service, Brooke Army Medical Center, Fort Sam Houston, Texas
*
Infectious Disease Service, HSHE-MDI, Brooke Army Medical Center, Fort Sam Houston, TX 78234-6200
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectve:

To determine the cause of clustered bacteremias occurring among chronic hemodialysis patients.

Design:

A retrospective investigation of clinical and laboratory records with direct observation of dialysis facilities and technique. Bacterial blood isolates were identified and compared with environmental isolates.

Setting:

The 1 1-station chronic hemodialysis unit that serves approximately 50 patients in a 450-bed military hospital.

Patients:

Hemodialysis unit patients with aerobic gram-negative bacillus orEnterococcus casseliflavus blood isolates between April 1988 and February 1990.

Results:

The recovery and species identification of the unique isolate, Ecasseliflavus, from 2 index cases of bacteremia in February 1990 helped identify the cluster and demonstrated its protracted course. Dialysis blood tubing was contaminated with ultrafiltrate waste during dialyzer setup.

Intervention:

Bacteremias were controlled by halting the practice of attaching the venous tubing directly to a waste container while priming the membrane, by emphasizing glove changes and handwashing after contact with ultrafiltrate waste and by daily decontamination of ultrafiltrate waste bags.

Conclusions:

We recommend that other hemodialysis units institute these interventions.

Type
Brief Report
Information
Infection Control & Hospital Epidemiology , Volume 13 , Issue 3 , March 1992 , pp. 160 - 164
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1992 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Jenkins, SR, Lin, FYC, Lin, RS, Israel, E, Petersen, NJ. Pyrogenic reactions and Pseudomonas bacteremias in a hemodialysis center. Dial Transplant. 1987;16:192–197.Google Scholar
2. Kantor, RJ, Carson, LA, Graham, DR, Petersen, NJ, Favero, MS. Outbreak of pyrogenic reactions at a dialysis center: association with infusion of heparinized saline solution. Am J Med. 1983;74:449–456.CrossRefGoogle Scholar
3. Facklam, RR Collins, MD. Identification of Enterococcus species isolated from human infections by a conventional test scheme. /Clin Microbiol. 1989;27:731–734.CrossRefGoogle ScholarPubMed
4. Favero, MS, Carson, LA, Bond, WW, Petersen, NJ. Factors that influence microbial contamination of fluids associated with hemodialysis machines. Appl Microbiol. 1974;28:822–830.CrossRefGoogle ScholarPubMed
5. Mion, CM, Canaud, B, Garred, LJ, Stec, F; Nguyen, QV. Sterile and pyrogen-free bicarbonate dialysate: a necessity for hemodialysis today. Adv Nephrol. 1990;19:275–314.Google ScholarPubMed
6. Luehmann, DA, Keshaviah, PR, Ward, RA, Klein, E, Thomas, A. A Manual on Water Treatment for Hemodialysis. US Department of Health and Human Services Publication FDA 89-4234; 1989.Google Scholar
7. Doern, GV, Brogden, BE, DiFederico, JD, Earls, JE, Quinn, ML. Quantitative microbiological monitoring of hemodialysis fluids: evaluation of methods and demonstration of lack of test relevance in single-pass hemodialysis machines with automatic dialysate proportioning with reverse osmosis treated tap water. /Clin Microbiol. 1982:16:1025–1029.CrossRefGoogle ScholarPubMed
8. American National 'Standard for Hemodialysis Systems. Arlington, Va: Association for the Advancement of Medical Instrumentation; 1981.Google Scholar
9. Alter, MJ, Favero, MS, Moyer, LA, Miller, JK, Bland, LA. National surveillance of dialysis-associated diseases in the United States, 1988. ASAIO Trans. 1990;36:107–118.CrossRefGoogle ScholarPubMed
10. Bernick, JJ, Port, FK, Favero, MS, Brown, DG. Bacterial and endotoxin permeability of hemodialysis membranes. Kidney Int. 1979;16:491–496.CrossRefGoogle ScholarPubMed
11. Alter, MJ, Favero, MS, Miller, JK, Coleman, PJ, Bland, LA. Reuse of hemodialyzers: results of nationwide surveillance for adverse effects. JAMA. 1988;260:2073–2076.CrossRefGoogle ScholarPubMed
12. Maki, DG, Agger, WA. Enterococcal bacteremia: clinical features, the risk of endocarditis, and management. Medicine.1988;67:248–269.CrossRefGoogle ScholarPubMed
13. Donowitz, LG, Marsik, FJ, Hoyt, JW, Wenzel, RP. Serratia marcescens bacteremia from contaminated pressure transducers. JAMA. 1979;242:1749–1751.CrossRefGoogle ScholarPubMed