Abstract
It is considered fully possible to perform clean preparation of dialysis fluid for hemodialysis therapy, provided that the user follows the manufacturer's instructions for cleaning and disinfecting the dialysis fluid delivery system (DDS). However, bacterial contamination in dialysis fluid would be observed in many hemodialysis facilities. To evaluate the origin of bacterial contamination in the system, we prospectively observed under daily regular use of DDS in a facility since August 2004 for three years. We measured bacterial endotoxin activity in dialysis fluid twice a week. We also recorded all of events on the system (daily preparation of dialysis fluid, cleaning and disinfecting, breakdown and preventive maintenances), and whether the procedures were performed with or without hand hygiene. During the observation period, the relation of endotoxin activity and events on the system was analyzed. Cleaning and disinfecting of the system itself reduced endotoxin activity. However, the manufacturer's instructions for reducing the bio-burden were insufficient to avoid contamination of the system. Twenty-four of 110 breakdown and preventive maintenance procedures were performed after hand washing and wearing gloves through out all hours of operation, and the other 86 without hand hygiene. Endotoxin activity remained constant with adequate hand hygiene, but significantly increased from 0.0177±0.0153 to 0.0206±0.0208 EU/mL without hand hygiene (p=0.016). We concluded that avoiding contamination by performing appropriate hand hygiene technique is essential to minimize the bio-burden during hospital preparation of dialysis fluid.
