When do many of you take your RO cultures? from the loop and RO. How long after. Same day,two day, a week ? Thanks

Every 14 days. And before and after disenfection.

We do our cultures monthly unless we identify a problem and then more frequently as needed. We draw from various machines on the loop and from the post RO permeate line as well. Because we have 2 different loops we have to make sure that we draw from each loop. Any questions feel free to contact me directly

We culture all dialysis machines monthly. We also test our central ROs monthly in addition to doing an LAL. On portable ROs we do only a monthly culture.

The draft of AAMI RD52 states: " The microbial quality of water should be monitored at least monthly to validate the effectiveness of the disinfection program. Monitoring can be accomplished by direct plate counts in conjunction with the measurement of bacterial endotoxin. Samples of water should be collected from several places to give an indication of the microbial quality of the water throught the water distribution system. In general samples should be collected in the following areas: from the first and last outlets of the water distribution loop, where water enters equipment used to reprocess dialyzers, and where water enters equipment used to prepare bicarbonate concentrate or from the bicarbonate concentrate mixing tank."

This draft is up for comments until March 23, 2004.

Has any one tried the LAL pyrogen test being supplied by Minntech? is it as easy as tghey say?

I am having a problem with my post bicarb loop cultures. They are high to often. It was sugjested to me,that I take the cultures one week after the RO is disinfected. I was colecting cultres 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.

The cultures are supposed to drawn at the longest period after disinfection, the worst possible case.

How often to you disinfect the bicarb loop? The longest recommended interval I know is weekly.

CMS gives you some allowance for practicality. If there is no one to draw cultures on a Saturday or if your lab can not accept cultures, LAL's on Saturday, you could draw them on Thursday.

Please explain worst possible case. I do my cultures monthly, on a Tuesday. I fedex them overnight on ice to the lab. What is CMS? I am fairly new to the technical end but not new to Dialysis please be patient with my questions. I have to teach myself everything.
What are the sources that that tell you to collect cultures well after the RO disnfection. Thank you for your help

Another one dropped into the fire head first. Poor thing.

quote:

Originally posted by pattypf1:
Please explain worst possible case. I do my cultures monthly, on a Tuesday. I fedex them overnight on ice to the lab. What is CMS? I am fairly new to the technical end but not new to Dialysis please be patient with my questions. I have to teach myself everything.
What are the sources that that tell you to collect cultures well after the RO disnfection. Thank you for your help

CMS is the Center for Medicare and Medicaid Services. They provide government payment for dialysis. In order to receive that payment, you have to meet certain conditions, called Conditions for Coverage. If you fail to meet those conditions, the government can shut down your facility or withhold payment.

There is an organization called the Association for the Advancement of Medical Instrumentation (AAMI) that developes, among other things, technical standards for dialysis. CMS has adopted the 2004 AAMI water standards as part of the conditions for coverage.

ANSI/AAMI RD52:2004 Requirements as Adopted by Reference 42 CFR 494.40 (a)
7.2 Microbial monitoring methods
7.2.1 General: Samples before disinfect
Samples must always be collected before sanitization/disinfection of the water treatment system and machines.

The thought is if you disinfect right after disinfection, you may get a false sense of security. Bacteria could be building up to unsafe levels right before disinfection, and you wouldn't know it.

The thought is if you disinfect right after disinfection, you may get a false sense of security. Bacteria could be building up to unsafe levels right before disinfection, and you wouldn't know it.[/QUOTE] What Hank means to say there is the thought is if you "culture" right after disinfection,

quote:

Originally posted by Ktech:
The thought is if you disinfect right after disinfection, you may get a false sense of security. Bacteria could be building up to unsafe levels right before disinfection, and you wouldn't know it.

What Hank means to say there is the thought is if you "culture" right after disinfection,[/QUOTE]

Thanks. I meant culture right after disinfection.