Arena Service Manual
quantity of blood comes into contact with the external
environment, even if through specially prepared circuits.
9.8.2 Bacteria in Dialysis Systems
Gram-negative bacteria (those that do not hold the purple dye
when stained by the process called Gram's stain) live and can
multiply in water, even in DI (deionized) or RO (reverse osmosis)
water, which has only small amounts of organic matter. Gram-
negative bacteria can develop with tremendous speed in the water
and dialysate, encouraged by the presence of dextrose and by the
heating of the dialysate. Levels of contamination can range from
102 to 106 CFU (colony forming units) per milliliter in water
(AAMI, 1990, pp. 81-94) and can cause pyrogenic reactions (such
as fever, shaking, rigors, lowered blood pressure) and/or
septicemia (blood poisoning) (Favero, 1985, and AAMI, 1990, pp.
81-94).
Table 9-9 lists some types of Gram-negative bacteria found in
dialysis systems.
Table 9-9. Water-Born Bacteria Found in Hemodialysis
Pseudomonas Achromobacter
Flavobacterium Aeromonas
Acinetobacter Serratia
Alcaligenes Moraxella
9-34 157-1278-916, Rev A
March 2004
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