Prevent infection linked to the dialysis water in a hemodialysis center in Fez city (Morocco) (original) (raw)
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Journal of Hospital Infection, 2017
Background: Patients receiving haemodialysis are exposed to a large volume of dialysis fluid. The Italian Society of Nephrology (ISN) published guidelines and microbial quality standards on dialysis water (DW) and solutions to ensure patient safety. Aim: Aim of the study was to identify microbial and chemical hazards and to evaluate disinfection treatments quality in DW plants. Methods: In the years 2015 and 2016 water networks and DW plants (closed loop and online monitors) of nine dialysis wards of Italian hospitals, hosting 162 dialysis beds overall, were sampled on a monthly basis to determine the parameters provided by ISN guidelines. Chlorinated drinking water was desalinated by reverse osmosis and distributed to the closed loop which feeds all online monitors. Disinfection with peracetic acid was performed in all DW plants on a monthly basis. Findings: During the entire study period of 24 months 7 out of 9 DW plants (78%) recorded negative results for all investigated parameters. A closed loop contamination of Burkholderia cepacia was detected in a DW plant from January 2015 to March 2015. Pseudomonas aeruginosa was isolated from March 2016 to May 2016 in the closed loop of another DW plant. These microbial contaminations were eradicated by shock disinfection with sodium hypochlorite and peracetic acid, followed by water flushing. Conclusion: Our results highlight the importance of chemical and physical methods of DW disinfection. The maintenance of control measures in water plants hosted in dialysis wards ensures a microbial risk reduction for all dialysis patients.
Background: Patients under hemodialysis are exposed to remarkable volume of water. As dialysis water is in direct contact with patients' blood, absence of regular disinfection of pipes will facilitate the transfer of the endotoxins produced by bacteria in water to the patient's body. Thus, regular control of dialysis system and water disinfectant equipment is compulsory. This study aimed at comparing relative frequency of positive culture for microorganisms in piped water before and after filtration, culture of water after passing from pipes, and culture of dialysis fluid before entering the dialysis filter in hemodialysis section of Alzahra Medical Center (Isfahan, Iran). Methods: During 2010 and 2012, an interventional study was performed in Alzahra Hospital. Samples were taken from piped water before and after filtration and from dialysis fluid before passing from membrane. The obtained samples were cultured in tryptic soy agar (TSA) and the isolated bacteria were then evaluated. Interventions included the disinfection of pipes used for transmission of water and replacement of pipes in hemodialysis section. Findings: Purified water was studied before and after passing the pipes. Dialysis fluid was also assessed before and after the intervention. Bacteria had grown in eight out of 14 samples (57%) before the intervention. In fact, five samples developed Escherichia coli, three had pseudomonas, and one had candida. However, after the intervention, only one out of 14 samples was found to have bacteria (alcaligenes) after filtration and before entering dialysis water pipes. Conclusion: According to the results of this study, the probability of bacterial growth is very high in filtration system of dialysis water. Regular disinfection and microbial sampling and culture are hence crucial.
International Journal of Environmental Research and Public Health, 2012
Methods: The present report attempts to illustrate the positive impact on the microbiological quality of dialysis patients over a 15-year period through the progressive implementation of state-of-the-art technological strategies and the optimization of microbiological surveillance procedures in five dialysis units in Sardinia. Results: Following on better microbiological, quality controls of dialysis water and improvement of procedures and equipment, a drastic improvement of microbiological water quality was observed in a total of 945 samples. The main aim was to introduce the use of microbiological culture methods as recommended by the most important guidelines. The microbiological results obtained have led to a progressive refining of controls and introduction of new materials and equipment, including two-stage osmosis and piping distribution rings featuring a greater capacity to prevent biofilm adhesion. The actions undertaken have resulted in unexpected quality improvements. Conclusions: Dialysis water should be viewed by the nephrologist as a medicinal product exerting a demonstrable positive impact on microinflammation in dialysis patients. A synergic effort between nephrologists and microbiologists undoubtedly constitutes the most effective means of preventing dialysis infections.
Universal Journal of Pharmaceutical Research
Water treatment systems are a vital factor in dialysis therapy and precise control of hemodialysis water bacteriological quality is predominantly important in order to assurance a better quality of life of the hemodialysis patients. The purpose of this study was to detect the level of contamination in hemodialysis water and dialysate by bacteria in Mukalla Artificial Kidney Center and investigate the antimicrobial resistance patterns of isolated bacteria. Forty eight samples of water and dialysate were assembled weekly over a period of 3 months from 4 points. Bacteriological analysis of samples was carried out then antimicrobial susceptibilities patterns of isolated bacteria were concluded by disk diffusion method. The mean of total count of bacteria for dialysis water and dialysate were higher than the recommended values (100 CFU/ ml). The isolated bacteria which colonized the hemodialysis systems were mostly Gram-negative bacilli as Pseudomonas sp., Serratia sp., Citrobacter sp. ...
Microbiological quality of water and dialysate in a haemodialysis unit in Ponta Grossa-PR, Brazil
Journal of Applied Microbiology, 2007
Aims: The objective of the study was to determine the microbiological quality of samples of water and dialysate in a haemodialysis unit. Methods and Results: Seventy-two samples each of water and dialysate were collected during November 2003 to April 2004. The following microbiological analyses were performed: test for total and faecal coliforms, which produced negative results for all the samples; counts of total heterotrophic bacteria, where three samples of water and two of dialysate showed levels higher than those permitted by national standards; and endotoxin assay, which revealed high quantities only in samples of water that preceded reverse osmosis. Nonfermenting Gram-negative bacteria were identified in 54 samples of dialysate and in 26 samples of water. The test for adhesion to an inert surface showed that various bacteria were capable of forming biofilms. Twenty-seven per cent of the bacteria were resistant to sodium hypochlorite at 500 ppm for 10-min contact time. Sixty per cent of the isolates were resistant to three or more antibiotics. Conclusions: Water and dialysate can be a source of infection for patients who need haemodialysis. Significance and Impact of the Study: An adequate system for water treatment, disinfection of the haemodialysis system and microbiological monitoring of the water and dialysate are necessary to reduce bacteraemia and pyrogenia outbreaks.
Microbiological contamination of a hemodialysis center water distribution system
Revista Do Instituto De Medicina Tropical De Sao Paulo, 2009
O monitoramento microbiológico da água utilizada no procedimento de hemodiálise é de extrema importância, principalmente devido à imunodebilidade dos pacientes com insuficiência renal crônica. Nosso objetivo foi verificar qualitativa e quantitativamente a presença de bactérias na água de um centro de hemodiálise do interior do Estado de São Paulo. Foram realizadas 22 coletas de cada um dos cinco pontos do sistema de distribuição; 36 amostras de 19 máquinas de hemodiálise, prontas para utilização; quatro amostras do sistema de reuso e 13 amostras do sistema de armazenamento de água, empregando-se a técnica da membrana filtrante com poros de 0,22 µm para bactérias e de 0,45 µm para micobactérias. A identificação foi realizada através de métodos microbiológicos convencionais e de biologia molecular. Isolados bacterianos foram obtidos de sistema de distribuição (128), águas das máquinas (43) e sistema de reuso (3). Entre os isolados 32 foram de bacilos Gram-positivos, 120 bacilos Gram-negativos, 20 Cocos Gram-positivos e 11 micobactérias. Neste estudo, sugerimos que suprimentos de água para o Centro de Hemodiálise devam ser monitorados, adotando-se medidas profiláticas eficazes que minimizem a exposição destes pacientes imunodeficientes a fontes aquáticas ambientais contaminadas.
MICROBIOLOGICAL ANALYSES OF WATER FROM HEMODIALYSIS SERVICES IN SÃO LUÍS, MARANHÃO, BRAZIL
Braz. J. Microbiol., 2005
Rigorous control of water quality in hemodialysis services is extremely important in order to guarantee a better quality of life of the patients submitted to this treatment. The lack of adequate water monitoring has caused the death of various patients in the past. The objective of the present study was to determine the physicochemical and bacteriological characteristics of water used by hemodialysis services in hospitals of the city of São Luís, Maranhão, Brazil. Bacteriological analyses included the membrane filter method for the determination of total coliform bacteria, the Cult-Dipcombi-TTC-agar method for heterotrophic bacteria and the limulus amebocyte lysate method for the determination of endotoxins. Eighteen water samples obtained from three hospital units, six samples per hemodialysis service, collected directly at the pre-and posttreatment points, were analyzed. Microorganisms were detected in the water used by the hemodialysis services in two of the three hospital units (B and C) studied. No contamination with heterotrophic bacteria was observed in pretreatment samples, while endotoxin production was detected in 100% of the samples. In post-treatment samples, heterotrophic bacteria were detected in 66.6% of the samples and endotoxins in 33.3%. The microorganisms identified in unit B were Burkholderia cepacia, Alcaligenes xylosoxidans, Pseudomonas aeruginosa and Stenotrophomonas maltophilia. In unit C Flavimonas oryzihabitans, Ralstonia pickettii and Burkholderia cepacia were identified. A significant correlation was observed between the presence of endotoxins and the physicochemical characteristics of water such as turbidity and conductivity. These data indicate that two of the three hospital units studied should revise the control of their hemodialysis water system.
Nephrology Dialysis Transplantation, 2003
Introduction. Every week, haemodialysis patients are exposed to 400 l of water used for the production of dialysis fluids which, albeit with the interposition of a semi-permeable artificial membrane, come into direct contact with the bloodstream. It is therefore clearly important to know and monitor the chemical and microbiological purity of dialysis water. Methods. In this review, we analyse the sources of chemical and microbiological water contamination, and the problems involved in water purification systems and modalities. We also analyse the compliance of dialysis units with the microbiological standards established by the most widely accepted guidelines relating to the quality of dialysis fluids. Results. The risk of chemical contamination is due mainly to the primary pollution of municipal water, whereas the most important microbiological problem is the control of bacterial growth in the water treatment and distribution system. Dialysis water treatment implies various levels of pre-treatment, a final purification module (which, in many cases, is reverse osmosis: RO) and a hydraulic circuit for the distribution of the purified water. RO-based treatment systems produce water of optimal chemical and microbial quality, and so dialysis units need to concentrate on maintaining this quality level in the long term by means of effective maintenance and disinfection strategies. The most widely accepted standards for water purity are those recommended by the Association for the Advancement of Medical Instrumentation and the European Pharmacopea, which respectively allow bacterial growth of <200 and <100 c.f.u./ml, and an endotoxin concentration of <2 and <0.25 IU/ml. However, a number of multicentre studies have reported that 7-35% of water samples have bacterial growth of >200 c.f.u./ml, and up to 44% have endotoxin levels of >5 IU/ml.
Physical-chemical and microbiological characterization of water destined to hemodialysis
Revista Ambiente & Água, 2024
This research evaluated the physical-chemical and microbiological parameters of water and dialysate in four distinct hemodialysis units located in the southeast region of Brazil. The physical-chemical parameters evaluated were pH, electric conductivity, turbidity, alkalinity, free chlorine, nitrate, fluoride, chloride, sulfate, sodium, potassium, calcium, and magnesium ion concentrations. Microcystin was also quantified. The microbiological parameters evaluated were the detection of total coliform, total heterotrophic bacteria count (THB), and the isolation and identification of microorganisms in pre-reverse osmosis treatment and post-reverse osmosis treatment water samples and dialysate. The nitrate, fluoride and THB levels found in the water samples may present risk to the patient under hemodialysis treatment. Microcystin was detected in one of the potable water samples. Microorganisms were identified throughout the hemodialysis of the entire water treatment system, with Ralstonia sp. being the most frequent. The presence of emergent pathogenic bacteria highlighted in this study highlights the necessity of microbiological monitoring of water destined for hemodialysis.
Journal of Water and Health, 2022
The water treatment process is a vital factor for hemodialysis (HD) patients. This study aimed to assess the degree of contamination of HD water by bacteria at the HD center of Mohammedia, Morocco, in addition to evaluating the antimicrobial resistance of isolated bacteria. Fifty-four water samples were taken, the appropriate cultures were used to isolate the pathogenic bacteria, which were identified biochemically and molecularly by 16S RNA sequencing. Their susceptibility to antimicrobial drugs was determined by the disk diffusion method. Approximately 5.5% of water samples were above the norm. The isolated bacteria that colonized the HD systems were mostly Gram-negative bacilli, such as Stenotrophomonas maltophilia, Pseudomonas spp., and Burkholderia cepacian. Results of the antibiotics test showed remarkable resistance levels. Among Pseudomonas spp. and S. maltophilia, 10 strains were classified as multidrug-resistant (MDR), and 4 as extensively drug-resistant (XDR). The diversi...