CRITICAL EVALUATION

Hemodialysis

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Hemodialysis

Brief overview of the disease

Chronic Renal Failure is a serious medical issue around the entire world. The occurrence of this failure is constantly increasing on the daily basis. The major causes of failure are hypertension, diabetes mellitus, polycystic kidney diseases, chronic glumerulo nephritus, nephrotoxins drugs and obstructive uropathy. (Meguid 2005) Several lines of evidence have shown that microbiological purity of the haemodialysis water and dialysis fluid is essential for the prevention of the silent chronic inflammation associated with the last period haemodialysis next time, for the reduction of secondary amyloidosis arising from the last period haemodialysis next time, suppression of pyrogenic reactions, and for improved control of anaemia following chronic renal insufficiency (Maxwell 2002).

These problems are due primarily to the presence of bacteria, endotoxins and bacteria-derived products. Water used during dialysis sessions may be responsible for the transmission of an increasing number of infections, with extensive and severe outbreaks recently reported. Therefore, haemodialysis units require high quality water with much more stringent standards than for other uses. Method for purification of water used in a haemodialysis are comprised a variety of strategies to eliminate bacteria and chemical contaminants: active carbon filters, regular disinfection, sub-micron filters reverse osmosis, etc. At the same time as water was used in preceding period haemodialysis next time was not idle, the levels of bacteria-derived products and bacteria had to be adequately reduced (Manns, 2006, 120).

Despite these precautions, piping, membranes, tanks and other surfaces within the distribution system support favourable sites for bacterial adhesion and cell proliferation. Most of these bacteria, which can use traces of organic and inorganic nutrients, accumulate to get biofilms attached to the inner surface of the tubing or filters. Biofilm growth and detachment record for most of the planktonic bacteria in fresh water systems and might be responsible for contamination of haemodialysis waters, which can be caused by several factors, including ambient temperature, stagnation and the development of biofilms.

Bacterial growth and biofouling these systems represent potentially serious problems for medical applications because of the presence of bacteria or his products in the purified water. Bacterial fragments generated by such biofilms are able to resist the dialysis membrane and trigger an inflammatory response in a patient. The complete removal of contaminating microorganisms is considered to be almost impossible. Microbiological standards for management of water supplies in hospitals consider only bacterial enumeration by plating on standard growth media (Mueller-Hinton, blood agar, and trypticase soy agar), and do not specify the bacterial species present in these waters. However, the potential presence of bacteria, even in small numbers, may contribute to a lower quality of the dialysate. (Manns, 2006, 120).

Establishing the cause of the present bacteria, evaluating the effectiveness of disinfectants in the water treatment and distribution, and accurately assessing the risk associated with the presence of pathogens and opportunistic bacteria.

In the first step towards determining the bacterial diversity within the purification and distribution systems of a previous termhaemodialysisnext language measure, 28 samples of water, taken at fumy points in the water ...