The fluids used in dialysis are all water based. Water, which is necessary for life, is also a good environment for microorganisms. The result of this is quite simply that microbial growth, i.e., increased numbers of micro-organisms, results in the presence of endotoxins and the formation of metabolites. The situation is not favorable for dialysis and needs to be understood and corrected. In order to act in the right way we must analyze and synthesize the available information, which will lead us to decide what actions and precautions are necessary. The possible negative effects of a too-high microbiological content in dialysis fluid and the importance of hygiene have been well-documented.15,20,23,32,39,40
This chain of events depends on ensuring that the information and thus the understanding we get from that information is accurate. If it is not accurate, any actions taken may be inadequate and result in a situation we can no longer control.
The patient will be in contact with the dialysis fluid in every session of dialysis due to the phenomenon of backfiltration, which means that anywhere from 100 ml to multiple liters of dialysis fluid is filtered over the dialyzer membrane and into the blood. The problems that may occur when contaminated dialysis fluid is used range from the acute pyrogenic reaction to chronic reactions over time where no acute symptoms are identified. The immune defense system is, however, constantly tested by the presence of body foreign components in the dialysis fluid.6
This paper will discuss the microflora (the micro-organisms present in the microbial community) that occur in systems of fluids in dialysis, limits, and methods of cultivation and disinfection. Results presented are original data examples out of some 350 investigations of fluid systems in dialysis units around the world, using analytic methods.26 (Biomedical Instrumentation & Technology 2008;42:150-159)