Touch Contamination of Connection Devices in Peritoneal Dialysis-Aquantitative Microbiologic Analysis

Abstract

Objective To determine the level of bacterial contamination associated with touch contact of a connector set during peritoneal dialysis (PD). Design The experiment utilized a laboratory-based simulation of a bag exchange procedure. Deliberatetouch contamination of the connector set spike was followed by quantitative recovery of micro-organisms from the connector and, in some cases, the dialysis bag. Subjects Patients undergoing PD were used as the “test” group. Departmental secretarial and laboratory staff served as the comparative control group. Setting The patients were voluntary subjects from a PD outpatients unit and were tested in their own homes. Outcome The numbers of micro-organisms contaminating a connector set and entering the dialysis bag during a touch-contamination event were determined. Additionally we identified hand hygiene and, in particular, the care taken to dry the hands after washing as being highly relevant to microbial touch-contamination levels. Patient hand disinfection, as practised in most PD units, effectively reduced touch contamination to low levels. Results Touch contamination of a connector set with unprepared hands led to fewer than 100 micro-organisms translocating from fingers to the spike. If the hands were washed but not dried before touch contact was made, up to 4500 micro-organisms trans located to the connector set spike. Air-towel drying of washed hands before touch contact reduced the translocating numbers by 95% -99%. Hand disinfection, as routinely practiced by PD patients, reduced the bacterial numbers reaching the peritoneal cavity after touch contamination to <5. The range of micro-organisms isolated from the fingers of PD patients using hand disinfectants on a regular basis showed considerably more diversity than the control group. Conclusion Hand care prior to bag exchange has a major effect on touch-contamination levels. Accidental touch contact of connecting devices by unprepared hands using a PD-bag exchange procedure leads to the translocation of 500 micro-organisms or fewer to the connector device. If the hands are wet at the time of contact the number translocating can be as high as 4500. Hand drying with an air towel before touch contact reduces the numbers translocating by 95% -99%. Hand disinfection procedures carried out prior to bag exchange minimizes touch-contamination levels.

Prevention of infectious complications in peritoneal dialysis: best demonstrated practices

“…The importance of drying hands, regardless of the agent used, was clearly demonstrated in a study of the relationship of hand dampness after hand washing to bacterial translocation following touch contamination. Using a hot air drier, there was only a 40% decrease in bacterial numbers after 15 s of drying compared to a 100% decrease at 60 s. 47 Hand washing is a key to preventing contamination. The training nurse should provide specific instruction about hand washing including avoiding artificial nails, which increase bacterial counts on the hands.…”

Residual moisture determines the level of touch-contact-associated bacterial transfer following hand washing

“…In the course of studying hand hygiene practices in relation to touch contamination induced peritonitis in patients undergoing peritoneal dialysis, we made the serendipitous discovery that the single most important determinant of the number of micro-organisms translocating from an individual's fingers to the dialysis bag exchange equipment was the residual moisture remaining on the hands after washing [3]. When a patient's hands were carefully dried, bacterial contamination of the plastic connecting devices was very low.…”

Seasonal Variation in the Peritoneal Dialysis‐Related Infections: A Single Center Experience in the Mediterranean

“…Despite a number of technological advances, infection remains the leading complication of PD and contributes significantly to the patient morbidity and mortality. These infections have been associated with translocation of bacteria across the bowel wall , intra‐abdominal pathologies , hypokalemia , contamination , hand hygiene , surgical technique such as tunnel direction and also climate. This effect has been described in various climates around the globe and in the following discussion we will be referring briefly to the main outcomes of these respective studies.…”