9. Disinfection
a properly designed water treatment system, most of this bacteria
can be removed or controlled.
The center's water treatment system is usually where the
contamination starts when there is a problem. This is because
factors influencing growth can be complex. All of the components
of the water treatment system, given the right circumstances, can
promote bacteria growth.
The hemodialysis system, by being at the furthest downstream
point, is easily contaminated. The internal pathways are complex
and can serve as reservoirs of contamination.
The dialysis concentrates are acetate, acid, and bicarbonate.
Acetate and acid are normally not a problem, but bicarbonate is
food for the bacteria and supports rapid bacteria growth.
The dialyzer and dialyzer reprocessing system also must be looked
at as a potential contributor to bacteria contamination. If the
reprocessing system becomes contaminated, it could contaminate
the dialyzer and in turn, the hemodialysis Instrument.
9.13.3 Examine the Symptoms
An important clue as to where the source of the problem exists is
the type of patient symptoms reported or measured. For instance,
high bacteria counts of less than 2,000 cfu/mL may be acceptable
from the hemodialysis Instrument, but not from the water system.
Find out exactly where high counts are experienced. Know what is
acceptable and what is not.
If counts are randomly high from the water system, then
investigate what is different when they go high versus when tests
are normal. Decide if the symptoms exist at all feed lines, all
hemodialysis Instruments, or if the symptoms are localized to a
specific area.
Are patients exhibiting pyrogenic reactions? Are they random and
isolated, or consistent and localized? Find out the type of
symptoms experienced, the time the episode started, and the length
of the episode. These important questions can tie the outbreak into
some change made in procedures.
9.13.4 Analyze
Analyze all the information collected to localize the outbreak to a
contributor system or systems. Clues should be obvious in
identifying systems that are contaminated, but it may not be as
easy to identify the source and/or cause of the bacteria
157-1278-916, Rev A 9-45
March 2004
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