Arena Service Manual
contamination. The cause of the outbreak must be found and
eliminated.
Separate the information by system and analyze it on the
contaminated systems. Look for clues to find the source and/or
cause of the bacteria growth.
9.13.5 Look for the Source and Cause
The objective of gathering and analyzing all this information is to
locate the cause of the contamination and to take proactive
measures to guarantee this will not be the cause of any future
outbreaks. This is the way systems, procedures and techniques are
improved and bacteria growth is minimized.
For instance, if the problem is specific to the hemodialysis
machine, investigate the following:
Sampling
• Using aseptic techniques
• Disinfection of sample site
• Flushing before taking samples
• Sample site in path of disinfection
• Samples assayed promptly
• Correct lab procedures and techniques correct
Other contributors
• Treated water bacteria levels above 200 cfu/ml
• Use of non-treated water supply
• Instrument drain line not isolated from drain
• Excessive bicarbonate storage time after mixing
• Disinfection of bicarbonate, concentrate and disinfectants
• Dialyzer not reprocessed correctly (contaminated)
• Poor microbial quality of the water used to prepare the
bicarbonate concentrate
Disinfection procedures and techniques
• Following manufacturer's recommendations
• Frequency of disinfection
• Type of disinfectant
• Preparation
9-46 157-1278-916, Rev A
March 2004
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