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Should dialysis machines be disinfected between patients' shifts?
1Université Catholique de Louvain, Cliniques Universitaires St.Luc, Renal Unit, Brussels, Belgium. Andre.Stragier@pandora.be
Abstract:
The disinfection of dialysis machines is performed after each session in some units but only at the end of the day in other ones. In a multicentre study, in 15 units (five with and ten without disinfection after each session), the incidence of sero-conversion for HCV was reduced to zero, after reinforcement of general hygiene precautions only, without changing the above-mentioned machine disinfection policies. Recently reported episodes of blood contamination of dialysis machines beyond pressure transducers demonstrate that pressure isolator inspection and care should be added to the general hygiene precautions. In a second investigation, no difference was found in dialysate bacterial and endotoxin characteristics between dialysis machines, disinfected after each dialysis (n = 2) and those disinfected at the end of the day only (n = 2). In conclusion, the systematic disinfection of all dialysis machines after each session does not appear to help prevent HCV infection nor to have a detectable impact on optimal dialysate bacterial and endotoxin characteristics.
Insights
Routine dialysis machine disinfection after each session does not prevent Hepatitis C Virus (HCV) infection. Enhanced general hygiene is key for patient safety in dialysis units.
Area of Science:
- Nephrology
- Infectious Disease Control
- Healthcare-Associated Infections
Background:
- Dialysis machine disinfection protocols vary, with some units disinfecting after each session and others daily.
- Hepatitis C Virus (HCV) transmission remains a concern in hemodialysis settings.
- Previous studies suggest general hygiene reinforcement may impact infection rates.
Purpose of the Study:
- To evaluate the impact of dialysis machine disinfection frequency on HCV sero-conversion rates.
- To assess the effect of disinfection policies on dialysate bacterial and endotoxin levels.
- To determine if systematic post-session disinfection is necessary for infection prevention.
Main Methods:
- A multicenter study involving 15 dialysis units (5 with post-session disinfection, 10 without).
- Reinforcement of general hygiene precautions was implemented across all units.
- Second investigation compared dialysate quality in machines with different disinfection frequencies (n=2 each).
Main Results:
- HCV sero-conversion incidence was zero in all units after hygiene reinforcement, irrespective of disinfection policy.
- No significant difference in dialysate bacterial or endotoxin levels was found between machines disinfected after each session versus daily.
- Blood contamination beyond pressure transducers highlights the need for improved general hygiene.
Conclusions:
- Systematic disinfection of dialysis machines after each session does not appear to prevent HCV infection.
- Current disinfection policies have no detectable impact on optimal dialysate bacterial and endotoxin characteristics.
- Focusing on enhanced general hygiene and equipment inspection is crucial for infection control in dialysis.