Pyrogenic reactions associated with the reuse of disposable hollow-fiber hemodialyzers.
We investigated 18 pyrogenic reactions (PRs) that occurred between July 1 and 13, 1987, in 16 patients receiving long-term hemodialysis at one dialysis center in Illinois. We defined a case of PR as the onset of chills or fever (oral temperature, greater than or equal to 37.8 degrees C) in a patient who was afebrile and had no signs or symptoms of infection before a dialysis treatment. Pyrogenic reactions to dialysis sessions during the epidemic period (July 1 through 14) were associated with the use of a reused dialyzer (risk ratio, 6.2; 95% confidence interval, 0.8 to 45). The water used to rinse the dialyzers after use and to dilute the germicide for disinfecting the dialyzers contained high concentrations of endotoxins (greater than 6 ng/mL) and bacteria (greater than 10(4) colony forming units/mL). After reuse of dialyzers was discontinued at the center, the PR rate fell to pre-epidemic levels. We concluded that PRs were associated with reuse of dialyzers, probably contaminated with endotoxins. Active surveillance for PRs among patients undergoing long-term hemodialysis should be routine at all dialysis centers; an increase in PRs should prompt timely review of water treatment and dialyzer reprocessing systems.
Hospital Infections Program, Centers for Disease Control, Atlanta, GA 30333.
S M
SM
Gordon
M
M
Tipple
L A
LA
Bland
W R
WR
Jarvis
D001419:Bacteria / Q000302:isolation & purification; D004196:Disease Outbreaks; D004203:Disinfection / Q000379:methods; D004209:Disposable Equipment / Q000009:adverse effects*; D004731:Endotoxins / Q000302:isolation & purification; D004812:Epidemiologic Methods; D004866:Equipment Contamination / Q000517:prevention & control; D005334:Fever / Q000209:etiology*; D006801:Humans; D007087:Illinois; D007688:Kidneys, Artificial / Q000009:adverse effects*; D011749:Pyrogens; D014871:Water Microbiology
D004731:Endotoxins; D011749:Pyrogens