Dear Mary, What are the interpretations of having a unit P&P which states bicarb. can be mixed the night before and stored overnight if the solution is used within 24 hours? Also, can the bleach/RO cleaning of bicarb jugs, wands,lids etc. be left as a weekly instead of a daily rinse? Just about everyone I have had contact with mixes the bicarb solution at the begining of the day and cleans the bicarb equipment at the end of the day. I am aware of what I preceive as an important issue but have run up against the brick wall of "It's P&P here." Thanks

Hello gpc8-- From the outset I should advise you that I am not an expert in dialysis so I could not comment with authority on storing bicarb overnight--- However, I can say that regardless of what the "p&p" states-- if it is not in alignment with the current standards or practice, the facility can be in some hot water. Obviously the ideal in any situation is to take the safest and most conservative route in any situation. I would encourage you to find out what the current practices are. I would get the answers from the experts re: what effect would storage of up to 24 hours be on bicarb. From a legal standpoint (which I do feel qualified to address) if the current standards are to mix in the a.m. and clean in the p.m.-- any failure to do so in which patient(s) are injured-- could result in a lawsuit and in a difficult defensive posture. Check with the other Renal Web facilitators and pose your question to them as well. Thanks, Mary

Dear Mary, *I* know what the AAMI standards are; I'm *not* sure what is going on in the unit. Thanks for your help. I think I'll call the AAMI 800# and ask for a copy of the text pretaining to bicarb and jug cleanting. Maybe a hard copy willhave some effect.
Thanks, gpc

Matt Arduino of the CDC was kind enough to fax me an article from NN&I (date unkown)that has the following
recommendations from the CDC:
"Recommendations to Control Contamination of LBC"
(LBC=Liquid Bicarb Concentrate)

"Because LBC and bicarbonate dialysate are such excellant growth media for microorganisms, several control methods should be employed.
1)If concentrate is prepared from prepackaged powder mix, the concentrate should be prepared immediately prior to use.
2)If concentrate is used or prepared in bulk quantities, in should not be stored for extended periods, it should be used as soon as possible after manufacture or receipt.
3)Storage tanks and distribution lines should be drained and disinfected at least 2 times each week.
4)Individual concentrate containers should be rinsed, disinfected, and inverted to drain and dry at the end of each day.
5)Appliances used to mix the concentrate should be rinsed, disinfected and drained at least daily."

Dennis, Thank you for the info. Also, thanks to Matt Arduino of the CDC. I have the facts which can help. All the best, gpc