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Touch contamination of connection devices in peritoneal dialysis--a quantitative microbiologic analysis
1Department of Medicine, University of Auckland, New Zealand.
Objective:
To determine the level of bacterial contamination associated with touch contact of a connector set during peritoneal dialysis (PD).
Design:
The experiment utilized a laboratory-based simulation of a bag exchange procedure. Deliberate touch contamination of the connector set spike was followed by quantitative recovery of micro-organisms from the connector and, in some cases, the dialysis bag.
Subjects:
Patients undergoing PD were used as the "test" group. Departmental secretarial and laboratory staff served as the comparative control group.
Setting:
The patients were voluntary subjects from a PD outpatients unit and were tested in their own homes.
Outcome:
The numbers of micro-organisms contaminating a connector set and entering the dialysis bag during a touch-contamination event were determined. Additionally we identified hand hygiene and, in particular, the care taken to dry the hands after washing as being highly relevant to microbial touch-contamination levels. Patient hand disinfection, as practised in most PD units, effectively reduced touch contamination to low levels.
Results:
Touch contamination of a connector set with unprepared hands led to fewer than 100 micro-organisms translocating from fingers to the spike. If the hands were washed but not dried before touch contact was made, up to 4500 micro-organisms translocated to the connector set spike. Air-towel drying of washed hands before touch contact reduced the translocating numbers by 95%-99%. Hand disinfection, as routinely practiced by PD patients, reduced the bacterial numbers reaching the peritoneal cavity after touch contamination to <5. The range of micro-organisms isolated from the fingers of PD patients using hand disinfectants on a regular basis showed considerably more diversity than the control group.
Conclusion:
Hand care prior to bag exchange has a major effect on touch-contamination levels. Accidental touch contact of connecting devices by unprepared hands using a PD-bag exchange procedure leads to the translocation of 500 micro-organisms or fewer to the connector device. If the hands are wet at the time of contact the number translocating can be as high as 4500. Hand drying with an air towel before touch contact reduces the numbers translocating by 95%-99%. Hand disinfection procedures carried out prior to bag exchange minimizes touch-contamination levels.
Insights
Proper hand hygiene, especially thorough drying after washing, significantly reduces bacterial contamination during peritoneal dialysis (PD) bag exchanges. Patient hand disinfection effectively minimizes microbial transfer to the connector set, safeguarding against infection.
Area of Science:
- Microbiology
- Infectious Disease Prevention
- Nephrology
Background:
- Peritoneal dialysis (PD) requires regular bag exchanges, creating opportunities for microbial contamination.
- Touch contamination of the PD connector set is a potential route for bacteria to enter the peritoneal cavity.
- Effective hand hygiene practices are crucial to minimize infection risk in PD patients.
Purpose of the Study:
- To quantify bacterial contamination levels on PD connector sets following touch contact.
- To assess the impact of different hand hygiene methods on microbial translocation.
- To evaluate the effectiveness of patient hand disinfection in reducing contamination.
Main Methods:
- Laboratory simulation of PD bag exchange procedure.
- Deliberate touch contamination of connector set spikes.
- Quantitative microbial recovery from connector sets and dialysis bags.
- Comparison between PD patients and control staff groups.
Main Results:
- Unprepared hands led to <100 microorganisms translocating to the connector spike.
- Wet hands (post-washing, un-dried) resulted in up to 4500 translocated microorganisms.
- Air-towel drying reduced translocated microbes by 95-99%; routine patient hand disinfection reduced contamination to <5 bacteria.
Conclusions:
- Hand care, particularly drying after washing, critically impacts touch contamination levels during PD bag exchanges.
- Accidental touch contact with unprepared or wet hands can introduce significant microbial loads.
- Standard PD patient hand disinfection protocols effectively minimize touch contamination, ensuring patient safety.
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