Just curious how many people actually use these on their machines. I am thinking about putting them on ours but I'm really unsure if I need them. I am over aggressive on my disinfection procedures and always have exceptional cultures and LAL results. With my levels constantly below the standards, would it still be benificial to the patients?

Thanks

After just presenting this to our MD, I would like to know if anyone knows of where I can get some literature stating studies prove this is better?

Although I can't reference a specific source that says it's better, it seems to be the common belief that it will in fact provide better water/dialysate for the patient. However, you'll probably find MANY people that will tell you that the mechanical problems associated with such filters may offset the benefits, including myself.

Do tell.....I would like to know the pros and cons.

Skee,

There are no real clinical studies proving this to be a benefit, to this point it is only theoretical. The fact is, there has never been any harm to a patient by using water that met the original AAMI guidelines that were written in 1982.

Technology has advanced that makes detection of contaminants at lower levels possible, and manufacturers have jumped on the bandwagon seeing an opportunity to sell a new product no matter how useless it is.

Two sayings come to mind about this :
1. If it aint broke, don't fix it.
2. Just because we can do something dosn't mean that we should. (A quote from my boss)

Chuck

The fact here is that AAMI is changing their standards and the clinics must adopt and comply with these standards. We check Endotoxin Units down to 0.06EU and plan to move to 0.03EU. 0.03EU defines "ultrapure dialysate." (Section 4.3.2.2 of AAMI RD52:2004) I feel that the only way this attainable is by using an ultrafilter. I find it hard to believe that <0.06 EU can be obtained withour a Diasafe filter or other ultrafilter. AAMI is changing their standards as we speak, and the action levels will probably be <0.25 EU. After that, it will probably be 0.06EU or 0.03EU.


<ChuckW> - The current AAMI standards for action levels in dialysate are 50 CFU and 1 EU.
I am not sure what the 1982 standards were, but I think it was something like 2000 CFU and 12.5 EU. I am not disputing your theory regarding patinet harm, but if we can make the water safer for our patients, why wouldn't we? Obviously AAMI agrees, or the old 1982 standard would be the same today. I believe that if AAMI is the maximum, then we should be more procactive for our patient's sake. Should it take one patient dying to make us be proactive? It is always a better policy to be proactive than reactive.

Respectfuly submitted.

Jeez Chuck...whackin' the hornets nest with a big 'ol stick aren't we?...while i can't disagree with you competely, neither can i stand completely on your side... no studies i have read have shown direct harm from originol AAMI water quality standards, but studies have shown a link between cytokine response and inflamatory markers relative to low endotoxin/CFU levels...blah, blah, blah. This is fun...

Steve

I agree that with the use of high flux dialyzers that water quality standards have to be more stringent however, I think Chuck is right about manufacturers seeing this as a money maker. A well maintained water system which incorporates the proper components can achieve this w/o the redundancy (not to mention the mechanical problems) of inline ultra pure filters. Also, having the filters may cause one to be a little lax in maintaining the water system.

As for studies, I am so sick of them, everyone knows that they can be manipulated to achieve the desired results.

bkr and Steve,

It's true that inflamatory markers are lower with ultrapure dialysate but they have not been able to establish a link to morbidity and mortality.

As far as AAMI goes, I feel that the tightening of standards are now driven more by industry interests and the fact that the technology now exists to be able to test to lower levels than by any real need to do so.

Another instance where I feel AAMI has gone too far is with FREE chlorine and requiring carbon tanks. AAMI says that the maximum level of FREE chlorine is 0.5ppm but guess what....FREE chlorine is HARMLESS to levels as high as 8.0ppm. Here in Baltimore they only use FREE chlorine and the levels in our product water has NEVER gone over 0.5ppm but, since AAMI says you have to have carbon tanks, we had to install them. We used to use CA membranes in our RO's so the residual FREE chlorine was not an issue.

Chuck

Thats what I like about this forum, the occational discussions, differing opinions, and education.

This is why I love this site, some really good points with no name calling and the usual BS. Personally, believe it or not my cultures and lal's already meet the standard for ultra pure dialysate. I am lucky in my job that I have the time to disinfect my machines and ro's at least three times more than most people do, and I do it. So my point is would it be benificial to our patients to still use one or would I just be throwing money down the drain? All points are well taken and would love to here some more points. I have researched this on the web and there isn't a whole lot of studies, good studies that really support this.

New here, and hope I can contribute in the future. I am in the same boat as Skee. I have very good disinfection program with my machines which are in the "ultra pure range". Would it be a waste to add these filters?

Yes, a big waste of money. They're expensive and on a well designed system with quality Ultrafilters you are already taking precautionary methods to prevent bacteria and endotoxins from your water. If you are doing your cultures at the correct places and at the time longest from your disinfect procedures in order to make sure you are not growing, you're fine. I can't believe how many people say they're cultures are always good but they take them after disinfecting. Who are they fooling? Just themselves. I'd be more worried about culture results that are always zero then about occaisional slightly elevated colony counts.

Chiefa
So you think I should be worried about my cultures being around zero constantly? I'm not being a wise ass either. My machines are disinfected everyday. I make sure my portables run every other day at minimum and clean and disinfect the membranes a minimum of every two days. A high level disinfection is performed minimum of once a week. With so much disinfection going on how can anything grow? I have been doing this for over 15 years and have never had a problem except the occasional contaminated on which was rediculous anyway. I take my samples from almost every port imaginable aand at the end of the 1st run. Why would I need to worry about having great results when that's what I strive for?

yeah baaby...i knew there be some great responses today...

It wasn't me...

"My machines are disinfected everyday. I make sure my portables run every other day at minimum and clean and disinfect the membranes a minimum of every two days. A high level disinfection is performed minimum of once a week"

Allen:

Help me put this in perspective. What exactlt is your job? How many dialysis machines? How many portable ROs? How many people doing the work? How many hours a day do you work? Thanks in advance.