Infection Control and Hospital Epidemiology Publication Info
For individual subscriptions, please contact the The University of Chicago Press
University of Chicago Press Customer Service:
1.877.705.1878 (toll-free, U.S. & Canada)
1.773.753.3347 (international)
subscriptions@press.uchicago.edu
For information about institutional access to this title, please visit the Institutional Subscriptions page.
Epidemic Parenteral Exposure to Volatile Sulfur‐Containing Compounds at a Hemodialysis Center
Formats Available in JSTOR: PDF
Abstract(back to top)
OBJECTIVE. To determine the cause of acute illness on August 30, 2000, among patients at an outpatient dialysis center (center A).
DESIGN. We performed a cohort study of all patients receiving dialysis on August 30, 2000; reviewed dialysis procedures; and analyzed dialysis water samples using microbiologic and chemical assays.
SETTING. Dialysis center (center A).
PATIENTS. A case‐patient was defined as a patient who developed chills within 5 hours after starting hemodialysis at center A on August 30, 2000.
RESULTS. Sixteen (36%) of 44 patients at center A met the case definition. All case‐patients were hospitalized; 2 died. Besides chills, 15 (94%) of the case‐patients experienced nausea; 12 (75%), vomiting; and 4 (25%), fever. Illness was more frequent on the second than the first dialysis shift (16 of 20 vs 0 of 24, P < .001); no other risk factors were identified. The center’s water treatment system had received inadequate maintenance and disinfection and a sulfurous odor was noted during sampling of the water from the reverse osmosis (RO) unit. The water had elevated bacterial counts. Volatile sulfur‐containing compounds (ie, methanethiol, carbon disulfide, dimethyldisulfide, and sulfur dioxide) were detected by gas chromatography and mass spectrometry in 8 of 12 water samples from the RO unit and in 0 of 28 samples from other areas (P < .001). Results of tests for heavy metals and chloramines were within normal limits.
CONCLUSIONS. Parenteral exposure to volatile sulfurcontaining compounds, produced under anaerobic conditions in the RO unit, could have caused the outbreak. This investigation demonstrates the importance of appropriate disinfection and maintenance of water treatment systems in hemodialysis centers.
Bibliographic Information(back to top)
- Epidemic Parenteral Exposure to Volatile Sulfur‐Containing Compounds at a Hemodialysis Center
- Dejana Selenic , MD, Francisco Alvarado‐Ramy , MD, Mathew Arduino , MD, DrPH, Stacey Holt , MMSc, Fred Cardinali , BA, Benjamin Blount , PhD, Jeff Jarrett , MS, Forrest Smith , MD, Neil Altman , BS, MPH, Charlotte Stahl , MSN, RN, CIC, Adelisa Panlilio , MD, MPH, Michele Pearson , MD and Jerome Tokars , MD, MPH
- Infection Control and Hospital Epidemiology
- Vol. 25, No. 3 (March 2004) (pp. 256-261)
Notes and References(back to top)
This item contains 1 note(s).
Notes
Drs. Selenic, Alvarado‐Ramy, Arduino, Panlilio, Pearson, and Tokars and Ms. Holt are from the Division of Healthcare Quality Promotion, National Center for Infectious Diseases; Drs. Selenic and Alvarado‐Ramy are from the Epidemic Intelligence Service, Division of Applied Public Health Training, Epidemiology Program Office; and Mr. Cardinali and Drs. Blount and Jarrett are from the Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia. Dr. Smith is from the Ohio State Health Department, Columbus, Ohio. Mr. Altman and Ms. Stahl are from the Youngstown City Health District, Youngstown, Ohio.Address reprint requests to Jerome I. Tokars, MD, MPH, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, 1600 Clifton Road, MS E‐55, Atlanta, GA 30333.The authors thank the individuals in local and state health departments and the staff and physicians of dialysis center A who participated in the outbreak investigation.Use of trade names is for identification only and does not constitute endorsement by the Public Health Service or the U.S. Department of Health and Human Services.
Items Citing this Item (back to top)
5 item(s) in JSTOR cite this item
- A. C. Shay; L. G. MillerVol. 25, No. 11 (November 2004) pp. 894-895Stable URL: http://www.jstor.org/stable/10.1086/503489
- F. A. Amer; H. A. Mohtady; I. M. el‐Behedy; S. Khalil; Y. A. el‐Hendy; E. A. el‐Gindy; H. E. SalemVol. 25, No. 11 (November 2004) pp. 895-897Stable URL: http://www.jstor.org/stable/10.1086/503490
- W. L. ThompsonVol. 25, No. 11 (November 2004) pp. 899-900Stable URL: http://www.jstor.org/stable/10.1086/503492
- C. Llor; L. Morato; P. Robles; A. MasVol. 25, No. 11 (November 2004) p. 894Stable URL: http://www.jstor.org/stable/10.1086/503488
- A. Tietz; M. Dangel; A. F. WidmerVol. 25, No. 11 (November 2004) pp. 897-899Stable URL: http://www.jstor.org/stable/10.1086/503491