CONTAMINATION OF DIALYSIS WATER AND DIALY SATE - A SURVEY IN 30 GERMAN CENTERS

The contamination of bacteria and endotoxin in dialysis water and dial ysate of 30 dialysis centers in Germany was examined. Water samples we re obtained after treatment by reverse osmosis or other processing met hods. Collection of dialysis samples for bacterial, fungal, and endoto xin analysis was conducted before and 2 hours after start of hemodialy sis. In 17.8% of all water samples analyzed, the AAMI standard was exc eeded and bacterial and fungal counts greater than 200 cfu (colony for ming units)/mL were found. In 11.7% of all dialysate samples, higher c oncentrations than the recommendations for dialysate of 2000 cfu/mL we re found. The concentrations of endotoxins in water and dialysate vari ed between 0 and 95 endotoxin units in the water samples and 0 and 487 endotoxin units/mL in the dialysate samples. In 12.2% of all water sa mples, and 27.5% of all dialysate samples, values of 5 endotoxin units /mL were found. No correlation was found between the level of contamin ation of either water or dialysate in a specific center and the follow ing factors: water processing method (reverse osmosis of others), type of dialysate (acetate or bicarbonate), type of dialysate machine, or method of machine desinfection. In view of these results it is suggest ed that endotoxin testing, especially in the dialysate, should be a pa rt of regular quality control in dialysis.