[Dialysate bacteriological quality in a health district]

Abstract

Background: There is a serious lack of data in literature on the quality of dialysate used in haemodialysis units throughout Spain and there also exist discrepancies between clinical guides on criteria related to dialysate bacteriological quality.

Aim: Ascertain bacteriological quality of dialysate used in our area.

Materials and methods: Descriptive observational studies were carried out monthly and over a period of one year, at two haemodialysis units (unit A: third level public hospital using Monitral-Hospal monitors and unit B: state subsidised non-profit organisation using AK90-Gambro monitors. Tests were performed to determine cultures and endotoxins in water treated with reverse osmosis and in the dialysate. Results are expressed as means (range) and as percentage samples that comply with or deviate from the 2004 recommendations of the Association for Advancement of Medical Instrumentation.

Results: Cultures showed 7 (0-53), 100%<200, and 5 (0-50), 100%<200, cfu./ml in water treated with reverse osmosis and values of 226 (0-1000), 58%<200, and 75 (0-800), 92%<200, cfu./ml, were obtained in dialysate from units A and B, respectively. Endotoxins levels were 0,07 (0,05-0,15), 100%<0,25, and 0,34 (0,06-1,16), 70%<0,25, UE/ml in water treated with reverse osmosis and 725,72 (1,83-2.645), 90%>2 and 16 (0,05-60,87), 70%>2, UE/ml in dialysate from units A and B, respectively.

Conclusions: Water treated with reverse osmosis at both units shows good compliance of bacteriological criteria and an acceptable level of endotoxins. The dialysate shows good compliance of bacteriological criteria at unit B and inadequate compliance for unit A. Poor compliance of endotoxins criteria was observed especially in the case of unit A. It would be interesting to have published data on endotoxins levels in dialysate from other dialysis units in Spain, to know if it is possible to achieve the bacteriological quality recommended by the guides using the actual HD monitors without filters for the dialysate and to evaluate from the clinical point of view the utility and efficiency of these filters in conventional HD.