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Waterborne Pseudomonas septicemia

R Vanholder1, E Vanhaecke, S Ringoir

  • 1Nephrology Department, University Hospital, Ghent, Belgium.

ASAIO Transactions
|July 1, 1990
PubMed

Insights

Septicemia outbreaks in dialysis patients can occur even with standard water quality controls. Total water decontamination is essential to prevent these Pseudomonas infections, especially when reusing dialyzers.

Area of Science:

  • Infectious Diseases
  • Nephrology
  • Public Health

Background:

  • Dialysis units require stringent water quality control to prevent patient infections.
  • Pseudomonas species are opportunistic pathogens that can cause severe infections in immunocompromised individuals, such as dialysis patients.
  • Waterborne septicemias pose a significant risk in healthcare settings, particularly for patients undergoing hemodialysis.

Purpose of the Study:

  • To investigate a cluster of Pseudomonas-related septicemias in a dialysis unit.
  • To identify the source and contributing factors of the infections.
  • To evaluate the effectiveness of standard water quality monitoring and dialyzer reprocessing procedures.

Main Methods:

  • Retrospective analysis of patient blood cultures and clinical data.
  • Microbiological testing of tap water, dialysate, and reprocessed dialyzers.
  • Evaluation of the automated dialyzer reprocessing device and its sterilization process.

Main Results:

  • A cluster of four pyrogenic reactions and three cases of septicemia caused by Pseudomonas species (P. aeruginosa, P. maltophilia, P. vesicularis) occurred in dialysis patients.
  • The infections were linked to the use of formaldehyde-reprocessed dialyzers.
  • Low formaldehyde concentrations and inadequate mixing of sterilant in the reprocessing device were identified as critical failures.
  • Pseudomonas species were detected in the tap water used for rinsing and in the effluent of reprocessed dialyzers.

Conclusions:

  • Septicemias can occur despite adherence to preset bacterial contamination standards for water.
  • Inadequate sterilization during dialyzer reprocessing, even with standard disinfectants like formaldehyde, can lead to patient infections.
  • Total water decontamination is crucial for preventing waterborne infections in dialysis units, overriding standard bacterial count monitoring alone.

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