title: An outbreak of bloodstream infections arising from hemodialysis equipment.
abstract: An outbreak of 29 cases of bloodstream infection by 16 pathogens occurred during 8 months at two chronic hemodialysis centers. Consequences included 21 hospital admissions and removal of 23 dialysis catheters. An epidemiologic investigation comparing case-patients with uninfected controls showed that risk was significantly (P < .05) associated with having a catheter for vascular access; receiving treatment on a Monday, Wednesday, Friday schedule; and receiving treatment on one heavily contaminated dialysis machine. Culture studies and mock trials showed that bloodstream pathogens were present in a recently installed, commercially marketed attachment for disposal of spent priming saline and could enter blood line tubing directly or indirectly during dialyzer priming and tubing assembly. The outbreak was halted by measures directed at the attachment. Investigation of this problem demonstrated that microbial overgrowth in the attachment caused bloodstream infections and underscores the importance of microbiologic considerations in the design and use of hemodialysis equipment.
authors.affiliation: Department of Medicine and Pritzker School of Medicine, University of Chicago, University of Chicago Hospital, Illinois, USA. parnow@mcis.bsd.uchicago.edu
authors.forename: P M
authors.initials: PM
authors.lastname: Arnow
authors.forename: S
authors.initials: S
authors.lastname: Garcia-Houchins
authors.forename: M B
authors.initials: MB
authors.lastname: Neagle
authors.forename: J L
authors.initials: JL
authors.lastname: Bova
authors.forename: J J
authors.initials: JJ
authors.lastname: Dillon
authors.forename: T
authors.initials: T
authors.lastname: Chou
mesh_terms: D002177:Candidiasis / Q000453:epidemiology / Q000209:etiology*; D016022:Case-Control Studies; D002404:Catheterization / Q000009:adverse effects* / Q000295:instrumentation; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000295:instrumentation; D004196:Disease Outbreaks; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000453:epidemiology / Q000209:etiology*; D016908:Gram-Positive Bacterial Infections / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000009:adverse effects* / Q000295:instrumentation; D018805:Sepsis / Q000453:epidemiology / Q000209:etiology*