Microbiological quality of hemodialysis water: what are the risk factors?

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Gianmarco Troiano

Gianmarco Troiano1, Gabriele Messina2, Elisabetta Zanieri3, Valeria Li Donni4, Nicola Nante5, Lea Magistri6, Maria Beatrice Pulci7, Fabrizio Niccolini8

1 Post Graduate School of Public Health, University of Siena, Italy
2Associate Professor, Post Graduate School of Public Health, University of Siena, Italy
3 Public Health Laboratory, Azienda Sanitaria Toscana centro, Florence, Italy
4 Public Health Laboratory , Azienda Sanitaria Toscana centro, Florence, Italy
5 Full Professor, Post Graduate School of Public Health, University of Siena, Italy
6 Director, Hygiene and Health Organization, Hospital “Careggi”, Florence, Italy
7 Nurse, Hygiene and Health organization, Hospital “Careggi”, Florence, Italy
8 Director, Hygiene and Health organization, Hospital “Careggi”, Florence, Italy

Autore Corrispondente
Gianmarco Troiano, MD
University of Siena
Department of Molecular and Developmental Medicine
Area of Public Health.
2 Via A. Moro,
Siena, 53100. Italy
Mobile: (+39) 347-9512771;
E-mail: gianmarco.troiano@student.unisi.it
Fax: (+39) 0577-234090

 

Abstract

Background A dialyzed patient weekly gets in touch with a large amount of water (on average 350 liters) through the dialysis bath. It is therefore essential that this solution would have a high quality and purity. The aim of our study was to monitor the microbiological quality of the hemodialysis water in order to identify possible factors that could affect it.

Methods We conducted a cross-sectional study from January 2015 to October 2017 collecting the dialysis water in AOU Careggi. Samples were aseptically collected by specialized technicians and then transported under ice at 4 ° C to the Laboratory of Biological Hazards of USL Toscana Centro for laboratory analyses.

Results 126 water samples were collected. Coliforms, E. coli, Staphylococcus aureus, enterococci were not detected. Pseudomonas aeruginosa was found in only one sample. Both for CFU at 37 ° C and at 22 ° C, the type of device represented the only statistically significant risk factor (OR 15.21 and OR 10.25 respectively): SDS devices had a significantly higher risk of being positive for CFU at 37 ° C and 22 ° C.

Conclusions As our study demonstrated, the system producing dialysis water must be constantly monitored, especially in cases of SDS devices which may be subjected more frequently to a higher contamination, due to their discontinuous use.

 

Keywords: surveillance, hemodialysis, infections

Sorry, this entry is only available in Italian.

INTRODUZIONE

L’emodialisi è uno dei trattamenti per pazienti con insufficienza renale acuta e cronica e, alla fine del 2010, quasi un milione di persone erano in trattamento dialitico, il 60% delle quali in 5 paesi: USA, Giappone, Germania, Brasile, Italia (1).

Un paziente in dialisi entra in contatto settimanalmente con un’ingente quantità d’acqua tramite il bagno di dialisi, in media 350 litri. È pertanto essenziale che questa soluzione abbia un’elevata qualità e purezza in termini di corretta composizione elettrolitica, bassa concentrazione o assenza di inquinanti chimici organici e inorganici, bassa concentrazione o assenza di batteri, lieviti, funghi ed endotossine. Va ricordato che il circuito idraulico delle macchine dialitiche può promuovere la crescita batterica e la formazione di biofilm. Questi ultimi possono andare incontro a colonizzazioni batteriche che possono essere rilasciate o produrre endotossine capaci di penetrare le membrane dialitiche (2, 3) .

 

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