Epidemic Parenteral Exposure to Volatile Sulfur-Containing Compounds at a Hemodialysis Center

Selenic, Dejana; Alvarado‐Ramy, Francisco; Arduino, Matthew J.; Holt, Stacey C.; Cardinali, Fred; Blount, Benjamin C.; Jarrett, Jeffery M.; Smith, Forrest M.; Altman, Neil; Stahl, Charlotte; Panlilio, Adelisa L.; Pearson, Michele L.; Tokars, Jerome I.

doi:10.1086/502387

Cited by 11 publications

(11 citation statements)

References 14 publications

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“…The reasons for patients being exposed to such toxic chemicals were water treatment failures at the drinking water treatment plant or dialysis center, incompatible dialysis solutions and distribution equipment/materials, and inadequate rinsing of dialysis systems after disinfection or newly installed dialysis systems. Aluminum , fluoride , chloramines , sulfur , and nitrates have caused toxicity in patients due to water treatment failures. Water treatment failures at the drinking water provider level allowed aluminum and fluoride to be released at levels beyond the maximum allowable limits; and subsequent dialysis water treatment was inadequate in removing these substances.…”

Section: Outbreaksmentioning

confidence: 99%

“…Sulfate(s) Nausea, vomiting, chills, some with fever in 16 patients, 2 deaths; source water used to prepare dialysate contained volatile organic compounds (CS 2 , CH 3 , etc.) and additional failures (75) HEMODIALYSIS AND WATER QUALITY (24,25), chloramines (74), sulfur (75), and nitrates (27) have caused toxicity in patients due to water treatment failures. Water treatment failures at the drinking water provider level allowed aluminum and fluoride to be released at levels beyond the maximum allowable limits; and subsequent dialysis water treatment was inadequate in removing these substances.…”

Section: Chemicalmentioning

confidence: 99%

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Hemodialysis and Water Quality

Coulliette

Arduino

2013

Seminars in Dialysis

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Over 383,900 individuals in the U.S. undergo maintenance hemodialysis that exposes them to water, primarily in the form of dialysate. The quality of water and associated dialysis solutions have been implicated in adverse patient outcomes and is therefore critical. The Association for the Advancement of Medical Instrumentation has published both standards and recommended practices that address both water and the dialyzing solutions. Some of these recommendations have been adopted into Federal Regulations by the Centers for Medicare and Medicaid Services as part of the Conditions for Coverage, which includes limits on specific contaminants within water used for dialysis, dialysate, and substitution fluids. Chemical, bacterial, and endotoxin contaminants are health threats to dialysis patients, as shown by the continued episodic nature of outbreaks since the 1960s causing at least 592 cases and 16 deaths in the U.S. The importance of the dialysis water distribution system, current standards and recommendations, acceptable monitoring methods, a review of chemical, bacterial, and endotoxin outbreaks, and infection control programs are discussed.

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Section: Outbreaksmentioning

confidence: 99%

Section: Chemicalmentioning

confidence: 99%

Hemodialysis and Water Quality

Coulliette

Arduino

2013

Seminars in Dialysis

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“…For example, fever was present in only 4 of 16 casepatients. 1 The only findings exhibited by most case-patients were nonspecific in nature (eg, chills and nausea).…”

Section: Epidemic Parenteral Exposure To Volatile Sulfur-containing Cmentioning

confidence: 97%

“…1 Their symptoms included chills, nausea, vomiting, hypotension, hypoxemia, tachypnea, fever, leukopenia followed by leukocytosis with a profound left shift, toxic granulations, and Dohle bodies. Two patients died and two had positive blood cultures, one for Citrobacter.…”

Section: Epidemic Parenteral Exposure To Volatile Sulfur-containing Cmentioning

confidence: 99%