Gorke A, Kittel J
Klinikum Garmisch-Partenkirchen, II Internal Clinic, Murnau, Germany.
EDTNA ERCA J. 2002 Jul-Sep;28(3):130-3. doi: 10.1111/j.1755-6686.2002.tb00226.x.
The importance of bacteria and endotoxin free, sterile dialysis fluid for long term, high quality haemodialysis treatment is obvious and very much demanded (1,2). Dead spaces and connections between units (segments) of fluid production and delivery in elder systems are a continuous source for bacteria growth, biofilm generation and endotoxin release (3). After varying success with routine disinfection of system components showing partly fast recovery and growth of bacteria (i.e. < 48 hours) we changed to routine disinfection of the entire fluid production and distribution system. We call this'system disinfection'. We report the methods and results from observation of practice over 28 months of disinfection. The fluid system is composed of a soft water tank, reverse osmosis (double RO), RO fluid loop, central bicarbonate production and delivery system and dialysis stations with and without ultrafilter and citric-thermal disinfection before and after each haemodialysis. The system disinfection is carried out bimonthly with peracetic acid 3.5% in > 0.1% solution at a mean temperature of > 15 degrees C and at a minimum of 60 minutes of disinfection time. Samples for microbiological testing and endotoxin measurement were assessed 3-4 monthly at 7 measurement points. The tests were carried out 7 times on the 11th day (mean value [MV]) after routine system disinfection. The result was in 0.2 CFU/ml (MV) in 40 tests. The endotoxin levels (IU/L) were all < 0.25 except one at 0.325 in RO water. Endotoxin was assessed 5 times in 26 tests over 28 months. Samples were taken at 10.5 (MV) days after system disinfection. The Gel Clot or turbometric method was used. Efficient and preventive routine system disinfection of an entire dialysis fluid production and distribution system as standard in modern equipment - can support sufficient quality in dialysis fluid produced and distributed by elder and composed systems.
对于长期高质量血液透析治疗而言，无细菌和内毒素的无菌透析液至关重要，且需求量极大（1,2）。老式系统中液体生产和输送单元（部分）之间的死腔和连接部位是细菌生长、生物膜形成和内毒素释放的持续来源（3）。在对系统组件进行常规消毒取得不同程度成功后，发现细菌部分恢复生长迅速（即<48小时），于是我们改为对整个液体生产和分配系统进行常规消毒。我们将此称为“系统消毒”。我们报告了28个月消毒实践观察的方法和结果。液体系统由一个软水箱、反渗透（双RO）、RO液体回路、中央碳酸氢盐生产和输送系统以及透析站组成，每个血液透析前后均有或无超滤以及柠檬酸热消毒。系统消毒每两个月用3.5%过氧乙酸在>0.1%溶液中进行，平均温度>15摄氏度，消毒时间至少60分钟。微生物检测和内毒素测量的样本每3 - 4个月在7个测量点进行评估。在常规系统消毒后的第11天（平均值[MV]）进行了7次测试。40次测试结果为0.2 CFU/ml（MV）。除RO水中一次为0.325外，内毒素水平（IU/L）均<0.25。在28个月内的26次测试中对5次内毒素进行了评估。在系统消毒后10.5（MV）天取样。采用凝胶凝块法或比浊法。对整个透析液生产和分配系统进行高效且预防性的常规系统消毒作为现代设备的标准——可确保老式组合系统生产和分配的透析液具有足够质量。
