A New Procedure Allowing the Complete Removal and Prevention of Hemodialysis Biofilms

Abstract

Most currently used disinfectants for dialysis machines have a good bactericidal efficacy on biofilms but leave dead cells on the surface. This contributes to the regrowth of biofilm and the release of pyrogens. A new anti-biofilm procedure consisting of sequential treatment combining enzymes and detergents is able to detach adherent cells. The efficacy of this procedure was assessed both in vitro and in reality. For in vitro studies, a biofilm model was set up. Studies were also performed in reality in a clinically used dialysis machine. Biofilm removal was first monitored by image analysis. Then, the biomass was detached by scraping and quantified by plate counts and endotoxin level measurement. Treated samples were compared to untreated control samples. The procedure led to the complete detachment of the biomass, both in vitro and in the reality situation. The aim of thisprocedure is to replace or complete the usual disinfection methods for medical devices.

The Importance of Water Quality and Haemodialysis Fluid Composition

“…A biofi lm may also be present in the hydraulic circuit of the dialysis machine, where factors such as the use of liquid bicarbonate concentrate, the presence of areas of low fl ow or stagnation, or suboptimal sterilization procedures between uses play a role [16,17] . Once established, the removal of the biofi lm is diffi cult, although recently, a new approach has been described [18] .…”

Using Detachment‐Promoting Agents for the Prevention of Chronic Peritoneal Dialysis‐Associated Infections

“…Detachment‐promoting agents (DPA) have already proven their efficacy in both preventing and removing biofilms from surfaces (9–11). They present the advantage to detach adherent cells from contaminated surfaces.…”

Using an efficient biofilm detaching agent: an essential step for the improvement of endoscope reprocessing protocols

“…6 This has been confirmed in situ following experimental contamination of actual dialysis machines, suggesting that biofilm removal should be attempted with cleaning agents rather than disinfectants. 7 The anti-biofilm efficacy of a cleaning agent should be related to its ability to detach biofilm from a surface. A new anti-biofilm procedure, the Pronetron â procedure, has been developed recently for the disinfection of haemodialysis machines.…”

“…A new anti-biofilm procedure, the Pronetron â procedure, has been developed recently for the disinfection of haemodialysis machines. 7,8 This procedure provides complete detachment of biofilm due to sequential and synergetic action of two detachment promoting agents: 9 a complex enzymatic mixture (Pronetron a) and a specific alkaline detergent solution (Pronetron b). The Pronetron agents can be used for preventive maintenance (preventing the development of a biofilm) based on the use of a detergent solution alone, and corrective maintenance (removal of an existing biofilm) based on enzymatic treatment followed immediately by treatment with an enriched detergent solution.…”