Nephrology Dialysis Transplantation, Vol 13, Issue 4 949-954, Copyright © 1998 by Oxford University Press
M Arvanigidou, S Spaia, C Katsinas, P Pangidis, T Constantinidis, V Katsouyannopoulos and G Vayonas
Background: Bacterial contamination of treated water
and dialysate comprises an important problem for patients undergoing
haemodialysis. Both the progressive reduction of the thickness of cellulose
membranes and the expanding use of high-flux membranes probably enhance the
risk of pyrogenic reactions, therefore increasing the need for atoxic water
and non-pyrogenic dialysis fluid. Methods: Samples of
tap water, treated water, and effluent dialysate in all 85 haemodialysis
centres in Greece were examined for total heterotrophic bacteria counts
employing the pour plate method, total and faecal coliforms, faecal
streptococci and pseudomonas spp. using the membrane filter technique, and
sulphite-reducing clostridia applying the most probable number method.
Overall 255 paired samples were tested from January to March 1997.
Results: For total heterotrophic bacteria, the overall
compliance of treated water and dialysate to the American Association of
Medical Instrumentation standards (<200 c.f.u./ml for water and
<2000 c.f.u./ml for dialysate) was 92.6 and 63.7% respectively,
whereas the compliance of tap water samples to our national standards
(total heterotrophic bacteria (<10 c.f.u./ml and absence of the
other indicator bacteria) was 80.7%. The most commonly isolated bacteria
were pseudomonas spp., found in 22.2% of treated water and 59.5% of
dialysate samples, whereas the respective frequencies were 12.3 and 36.2%
for total coliforms, 8.6 and 30.0% for faecal coliforms, 14.8 and 28.7% for
faecal streptococci, and sulphite-reducing clostridia were isolated in 5.8%
of dialysate samples only. Haemodialysis centres equipped with storage
tanks for treated water experienced lower levels of total heterotrophic
bacteria but higher counts of total and faecal coliforms, faecal
streptococci, and pseudomonas spp., although the difference was
statistically significant only for faecal streptococci counts,
(P<0.05). Sixty-seven haemodialysis centres were equipped with
bacterial filters, but mean values of all the examined microorganisms were
not statistically different form those of the other centres. Faecal
streptococci counts in treated water samples were positively correlated
with ageing of both haemodialysis centres (P<0.005) and purification
system (P<0.05), whereas pseudomonas counts were significantly
correlated with ageing of the purification system (P<0.05).
Key words: bacterial contamination; coliforms;
haemodialysis; quality of water treatment; pseudomonas spp.; streptococci
ORIGINAL ARTICLES
Microbiological quality of water and dialysate in all haemodialysis centres of Greece
Renal Department, 2nd Hospital of IKA, Greece; Laboratory of Hygiene, Medical School, University of Thessaloniki, 54006 Thessaloniki, Greece; Corresponding author
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