Highlights
- •Two-step filtration is an excellent method to improve water safety for hemodialysis and likely other departments.
- •Water-borne pathogens are likely to form a biofilm that is once formed, is extremely difficult to eradicate.
- •High volume membrane filtration is a more accurate way than direct culture to identify water pathogens.
Introduction
Reverse osmosis (RO), a major advance in hemodialysis (HD) safety, effectively clears
most water organisms. Delftia acidovorans is an environmental water-borne pathogen that is rarely reported to cause human infections.
We report a pseudo outbreak caused by colonization of RO machines with D acidovorans with no reported human infections and interventions to improve HD safety.
Methods
Repeated positive RO product water cultures triggered our hospital to initiate an
investigation, RO machines were examined for mechanical integrity by biomedical engineers.
Cultures of product water as well as RO parts were done. Testing for bacterial relatedness
after identification was performed. An investigation was conducted in a systematic
fashion to determine the cause and the extent of the problem.
Results
Upon formal review of policies and procedures, there were minor deficiencies. Rectifying
these deviations from policies did not stop the repeated positive water cultures.
A 7-step investigation and correction was successfully conducted. City water testing
with filtration and concentration methods was positive for D acidovorans. Major renovation of the HD unit with replacement of all RO machines and a 2-step
water filtration resulted in elimination of the pseudo outbreak.
Conclusion
City water was the source of biofilm formation of D acidovorans in RO machines that was not possible to eradicate. Application of incoming water
filters was an effective preventive strategy. Replacement of RO machines after 4 failed
disinfection attempts is the most cost-effective strategy as well for persistent positive
water cultures. The HD remains RO water culture negative 2 years after changes.
Key Words
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Article info
Publication history
Published online: January 14, 2020
Identification
Copyright
© 2019 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
