Does anyone know if there are any AAMI Recomendations on how frequently the Bicarb Loops need cultures and LAL's drawn and how often is everybody testing their own loops.

FMC policy is monthly.

We test monthly as well

Our policy has us do it monthly also.

monthly here

DCI testes weekly on the return loop monthly on the mix and holding tanks and then a loop start culture monthly also

RD52 states that "No recommendations are made regarding the bacteriology of concentrate prepared at a dialysis facility." There are limits for dialysate and water, but not concentrate. RD52 also states "This decision was based on the difficulty of performing cultures and endotoxin assays in samples with high concentrations of salts. High concentrations of bicarbonate require special culturing techniques and are inhibitory in the LAL assay. The committee determined that it was unreasonable to require an individual dialysis facility to meet the special conditions required for proper testing of bicarbonate concentrate and that patients would be adequately safeguarded by the quality
recommendations for the water used to prepare the concentrate and for the final dialysate." Also from RD52 "Monitoring of bicarbonate concentrate produced at a dialysis facility from powder and water, though not required routinely, may be undertaken as part of a troubleshooting investigation. The sodium content of TSA is sufficient for use in culturing bicarbonate concentrate without supplementation. However, if Reasoner’s 2A or
TGEA is used to monitor microbial contamination in bicarbonate concentrate, it may be necessary to supplement the media with 4 % sodium bicarbonate."

Personnally, it sounds like the TSA method can be used for bicarb. And, it is always good to test the bicarb solution although it is not necessary to apply the 50 cfu/ml limit to the result since the amount of bicarb solution in the diaysate is only a small portion of the dialysate. The AAMI limit is on the overall dialysate.

Florian the water guy gave me another question. Is everybody testing their loops with bicarb in it or just the recirculating rinse water.

We test our cultures and endotoxins with the bicarb in the system.

We test with bicarb in the system. The lowest LAL reading Spectra can give us is <0.5 because of the bicarb.

We test ours pre and post ozone disinfection with rinse water not bicarb. We do this on a monthly basis.

We culture our bicarb loops prior to each disinfection using the bicarb still in the system. We do not do LAL's on the bicarb. Only the RO loop.

Can you help me.I am having a problem with my post bicarb loop cultures. They are high to often. It was mentioned to me,that I take the cultures one week after the RO is disinfected. I was collecting cultures on a Tuesday, because the RO was done on Sunday. Does disinfecting the RO disturb bacetria as was stated to me and that is why cultures should be done on week after the RO disinfection. Is there a protocol on testing?

I think the point is that you should take cutures as far away from the last disinfection to being as close as possible to next disinfecion. That would be worst case scenerio. Not a good thing if you're disturbing bacteria from the pipe walls as there really shouldn't be any. Can you disinfect more often?

What type of bicarb system do you have? How frequently and what do you use for disinfection of the bicarb loop?