| An outbreak of gram-negative bacteremia in hemodialysis patients traced to hemodialysis machine waste drain ports. | |
| | |
MedLine Citation:
|
PMID: 10580625 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
|
OBJECTIVE: To investigate an outbreak of gram-negative bacteremias at a hemodialysis center (December 1, 1996-January 31, 1997). DESIGN: Retrospective cohort study. Reviewed infection control practices and maintenance and disinfection procedures for the water system and dialysis machines. Performed cultures of the water and dialysis machines, including the waste-handling option (WHO), a drain port designed to dispose of saline used to flush the dialyzer before patient use. Compared isolates by pulsed-field gel electrophoresis. SETTING: A hemodialysis center in Maryland. RESULTS: 94 patients received dialysis on 27 machines; 10 (11%) of the patients had gram-negative bacteremias. Pathogens causing these infections were Enterobacter cloacae (n = 6), Pseudomonas aeruginosa (n = 4), and Escherichia coli (n = 2); two patients had polymicrobial bacteremia. Factors associated with development of gram-negative bacteremias were receiving dialysis via a central venous catheter (CVC) rather than via an arterio-venous shunt (all 10 infected patients had CVCs compared to 31 of 84 uninfected patients, relative risk [RR] undefined; P<.001) or dialysis on any of three particular dialysis machines (7 of 10 infected patients were exposed to the three machines compared to 20 of 84 uninfected patients, RR = 5.8; P = .005). E cloacae, P aeruginosa, or both organisms were grown from cultures obtained from several dialysis machines. WHO valves, which prevent backflow from the drain to dialysis bloodlines, were faulty in 8 (31%) of 26 machines, including 2 of 3 machines epidemiologically linked to case-patients. Pulsed-field gel electrophoresis patterns of available dialysis machine and patient E cloacae isolates were identical. CONCLUSIONS: Our study suggests that WHO ports with incompetent valves and resultant backflow were a source of cross-contamination of dialysis bloodlines and patients' CVCs. Replacement of faulty WHO valves and enhanced disinfection of dialysis machines terminated the outbreak. |
| | |
Authors:
|
S A Wang; R B Levine; L A Carson; M J Arduino; T Killar; F G Grillo; M L Pearson; W R Jarvis |
Related Documents
:
|
8105905 - Dialysis therapy among elderly patients; data from the canadian organ replacement regis... 8909935 - Measurement of total body water by bioelectrical impedance in chronic renal failure. 14564195 - Oxidative stress in uremia. 2349955 - Hemolysis associated with hydrogen peroxide at a pediatric dialysis center. 5274155 - Lung function in patients receiving busulphan. 8474265 - Urolithiasis in pediatric patients. |
Publication Detail:
|
Type: Journal Article |
Journal Detail:
|
Title: Infection control and hospital epidemiology : the official journal of the Society of Hospital Epidemiologists of America Volume: 20 ISSN: 0899-823X ISO Abbreviation: Infect Control Hosp Epidemiol Publication Date: 1999 Nov |
Date Detail:
|
Created Date: 1999-12-14 Completed Date: 1999-12-14 Revised Date: 2004-11-17 |
Medline Journal Info:
|
Nlm Unique ID: 8804099 Medline TA: Infect Control Hosp Epidemiol Country: UNITED STATES |
Other Details:
|
Languages: eng Pagination: 746-51 Citation Subset: IM; N |
Affiliation:
|
Hospital Infections Program, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA. |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
Ambulatory Care Facilities Cohort Studies Cross Infection / epidemiology, etiology* Disease Outbreaks* Equipment Failure Gram-Negative Bacterial Infections / epidemiology, etiology* Humans Maryland / epidemiology Renal Dialysis / adverse effects*, instrumentation Retrospective Studies Risk Factors |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: "Pulse" nasal mupirocin maintenance regimen in patients undergoing continuous ambulatory peritoneal ...
Next Document: A Canadian survey of prophylactic antibiotic use among hip-fracture patients.