Infection Control and Hospital Epidemiology Publication Info
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An Outbreak of Gram‐Negative Bacteremia in Hemodialysis Patients Traced to Hemodialysis Machine Waste Drain Ports
Formats Available in JSTOR: PDF
Abstract(back to top)
OBJECTIVE. To investigate an outbreak of gram‐negative bacteremias at a hemodialysis center (December 1, 1996‐January 31, 1997).
DESIGN. Retrospective cohort study. Reviewed infection control practices and maintenance and disinfection procedures for the water system and dialysis machines. Performed cultures of the water and dialysis machines, including the waste‐handling option (WHO), a drain port designed to dispose of saline used to flush the dialyzer before patient use. Compared isolates by pulsed‐field gel electrophoresis.
SETTING. A hemodialysis center in Maryland.
RESULTS. 94 patients received dialysis on 27 machines; 10 (11%) of the patients had gram‐negative bacteremias. Pathogens causing these infections were Enterobacter cloacae (n=6), Pseudomonas aeruginosa (n=4), and Escherichia coli (n=2); two patients had polymicrobial bacteremia. Factors associated with development of gram‐negative bacteremias were receiving dialysis via a central venous catheter (CVC) rather than via an arterio‐venous shunt (all 10 infected patients had CVCs compared to 31 of 84 uninfected patients, relative risk [RR] undefined; P<.001) or dialysis on any of three particular dialysis machines (7 of 10 infected patients were exposed to the three machines compared to 20 of 84 uninfected patients, RR=5.8; P=.005). E cloacae, P aeruginosa, or both organisms were grown from cultures obtained from several dialysis machines. WHO valves, which prevent backflow from the drain to dialysis bloodlines, were faulty in 8 (31%) of 26 machines, including 2 of 3 machines epidemiologically linked to case‐patients. Pulsed‐field gel electrophoresis patterns of available dialysis machine and patient E cloacae isolates were identical.
CONCLUSIONS. Our study suggests that WHO ports with incompetent valves and resultant backflow were a source of cross‐contamination of dialysis bloodlines and patients’ CVCs. Replacement of faulty WHO valves and enhanced disinfection of dialysis machines terminated the outbreak.
Bibliographic Information(back to top)
- An Outbreak of Gram‐Negative Bacteremia in Hemodialysis Patients Traced to Hemodialysis Machine Waste Drain Ports
- Susan A. Wang , MD, MPH, Rachel B. Levine , MD, Loretta A. Carson , MS, Matthew J. Arduino , DrPH, Teresa Killar , RN, F. Gregory Grillo , MD, Michele L. Pearson , MD and William R. Jarvis , MD
- Infection Control and Hospital Epidemiology
- Vol. 20, No. 11 (November 1999) (pp. 746-751)
Notes and References(back to top)
This item contains 1 note(s).
Notes
From the Hospital Infections Program (Drs. Wang, Levine, Arduino, Pearson, and Jarvis; Ms. Carson), National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, and Frederick Memorial Regional Dialysis Center (Dr. Grillo and Ms. Killar), Frederick, Maryland.Address reprint requests to Michele L. Pearson, MD, Hospital Infections Program, Mailstop E‐69, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30333.Use of trade names is for identification purposes only and does not imply endorsement by the Public Health Service or the US Department of Health and Human Services. Financial support information: no outside funding source was used. The authors wish to thank S. Jenny Boyer for providing her assistance in the investigation of this outbreak.98‐OA‐219. Wang SA, Levine RB, Carson LA, Arduino MJ, Killar T, Grillo FG, Pearson ML, Jarvis WR. An outbreak of gram‐negative bacteremia in hemodialysis patients traced to hemodialysis machine waste drain ports. Infect Control Hosp Epidemiol 1999;20:746‐751.
Items Citing this Item (back to top)
1 item(s) in JSTOR cite this item
- Carol Y. Rao , ScD; Constance Pachucki , MD; Salvatore Cali , MPH; Mangai Santhiraj , MPH; Kathi L. K. Krankoski , BS; Judith A. Noble‐Wang , PhD; David Leehey , MD; Subhash Popli , MD; Mary E. Brandt , PhD; Mark D. Lindsley , ScD; Scott K. Fridkin , MD; Matthew J. Arduino , DrPHVol. 30, No. 9 (September 2009) pp. 840-847Stable URL: http://www.jstor.org/stable/10.1086/605324