Has anyone had prolonged success with removing the "yogurt" buildup on drain lines of Fresenius machines. I have taken over center with machines that range from 30k to 6k hours. The nurses appear to be acid cleaning, bleaching, etc. properly. Anyone with any useful ideas or helpful discussion it would be appreciated. FYI acid clean runs 10 minutes as well as bleach draw cycle no prerinse.

tgy,

The machine should always be rinsed before bleaching it. The high ph of the bleach will solidify the calcium in the dialysate.

Once you have a heavy build-up of "yogurt" (which is actually pseudomonas) in the lines, it is very difficult to get rid of and you should replace the lines. After the lines are replaced, the key is preventing it from occuring in the first place.

In one of our facilities, we had a problem with it in our drain pipes that was so bad, we had to have a plumber snake out the line about every 3 weeks. We tried everything from using Drain-Gel to pouring straight bleach in the drains daily, neither of which solved the problem. What we finally found was that when the facility went from running 3x/week to running 6x/week they did not increase their frequency of bleaching the machines from 1x/week to 2x/week. Once they started doing the bleaching 2x/week, the problem was solved.

once you replace the lines, try setting your machine to prerinse 20 min during heat disinfect. This give the drain line about 5-6 min of 80 C water help kill the bugs. nurses wont like iot because it increases disinfect time.

Dman has the right idea. Once you've got the problem, you should replace the drain lines and start fresh. Increasing the heat rinse time worked for us and it's what was recommended at the Fresenius training.

We had the same problem with our Althin machines. The problem has hung around for almost a year. We increased our bleach cycles to 4/wk. Seems to be working. We replaced the heat cycle with the bleach cycle on Saturdays so the bugs won't have all of Sunday to multiply.

Had the same problem about a year ago at my unit. The yogurt is biofilm and it is a tough character to kill. Here's what worked for me. I had the clinical staff pour 50-100 cc of straight bleach down the side drains at the end of every treatment day. This took care of the problem within a week and it has not returned since. Hope this helps.

At my facility we had the same problem about a year after we opened up. When I opened some access panels to inspect the drains, I found that there was a flexable hose drain below the level of the main drain causing it to act a P trap. I raised the machine drain going to the main drain inside the wall so that there was a free fall of used dialysate to the main drain. What this would do is allow the used dialysate to empty in the drain line to the main drain thus no stagnant dialysate to grow anything.
Also, the the K machine will only use about 60cc of bleach during there chemical cycle. What it does is draw the bleach into the hydraulics and then recirculate it. whereas with the H machine it will draw about 170cc and not recirculate but send it directly to drain. Removing your drain lines rom the machine and soaking them in straight bleach for at least 1 hour and then flushing them with hot water will clear them usually.

For anyone interested in a study which looked at the relative effectiveness of various disinfection and cleaning protocols in removing biofilm in silicone tubing used on dialysis machines, look up the article "Biofilm removal from silicone tubing : an assessment of the efficacy of dialysis machine decontamination procedures using an in vitro model" K. Marion-Ferey et al, Journal of Hospital Infection (2003) Vol. 53 pp 64-71. They compared various combinations of disinfection methods (heat, bleach, Actril(R)) with or without pretreatments (various acids and Actril).

Fairly academic; but interesting. There conclusion was that 3% Citric Acid pretreatment and bleach disinfection gave the best removal rate for biofilm. Bleach without pre-treatment was next best (confirms the experience related in the earlier posting). They also concluded that heat made the problem worse- theoretically by "baking" or hardening the biofilm onto the tubing. An interesting study if you want to learn more about the problem. Ken Price- Serim Research

Heat may not be effective for removal, but sure seems to work for prevention, particularly when combined with vinegar(acid) and bleach.

From what I have been told (from PhD in Bio Chemistry), neither heat nor bleach will remove all of the buildup unless it is full strength bleach and very repetitive, it will just take the top few layers off. The extended heat disinfect will help, but the drain lines need to be replaced before initializing this because the buildup will still be present. Fresenius is developing an improved Chemical disinfect cycle that dumps more bleach down the drain. With the new Chemical disinfect and extended heat disinfect, this should solve these problems, but the drain lines need to be replaced for this to be 100% effective. I hope that this helps.

Wow... nobody know's why, huh? Well, I have a few theories that seem to hold water. I notice the biggest difference (and I'm talking day and night) is when we went from Reuse to Non-Reuse. In less than a month we had drainboards spilling over EVERYWHERE!! I believe the problem was that the drain lines and internals weren't getting rinsed with formaldehyde anymore and therefore allowing the buildup to start and then just get out of control. The only useful remedy I have used is replacing the drain lines, extending the pre-rinse to 20 min. and trying to make sure the clinical staff is doing there acid cleans and bleaches with NO EXCEPTIONS!! Or, depending on your clinic, get rid of the drain boards. I have recently moved to another company using the H's w/out drain boards and have found NO problems what so ever. Also, I wanted to make a correction. The Fresenius H doesn't take up more bleach than the K. It's the OLC that causes the K to take up less. If you had an H with OLC it would take the same as the K.

quote:

Originally posted by GTSCSS:
Wow... nobody know's why, huh? Well, I have a few theories that seem to hold water. I notice the biggest difference (and I'm talking day and night) is when we went from Reuse to Non-Reuse. In less than a month we had drainboards spilling over EVERYWHERE!! I believe the problem was that the drain lines and internals weren't getting rinsed with formaldehyde anymore and therefore allowing the buildup to start and then just get out of control. The only useful remedy I have used is replacing the drain lines, extending the pre-rinse to 20 min. and trying to make sure the clinical staff is doing there acid cleans and bleaches with NO EXCEPTIONS!! Or, depending on your clinic, get rid of the drain boards. I have recently moved to another company using the H's w/out drain boards and have found NO problems what so ever. Also, I wanted to make a correction. The Fresenius H doesn't take up more bleach than the K. It's the OLC that causes the K to take up less. If you had an H with OLC it would take the same as the K.

True. But if you have software version 8.02or earlier it does not have the OLC option and it will draw up almost 3 times the amount of bleach.