Abstract: TH-PO870
Evaluating Bacterial Flush Efficiency and Touch Contamination Across 3 Different Twinbag Systems
Session Information
- Peritoneal Dialysis - I
November 02, 2017 | Location: Hall H, Morial Convention Center
Abstract Time: 10:00 AM - 10:00 AM
Category: Dialysis
- 608 Peritoneal Dialysis
Authors
- Straka, Paul, Baxter Healthcare Corporation, Deerfield, Illinois, United States
- Sloand, James A., Baxter Healthcare Corporation, Deerfield, Illinois, United States
Background
Peritonitis is a significant complication of peritoneal dialysis (PD). PD system design to reduce touch contamination by at-home PD patients is critical in reducing peritonitis risk. Impact of connection-design differences on contaminant flush efficiency among three different Twinbag CAPD system was assessed by examining differences in the amount of bacteria entering the fluid path under worse case touch contamination.
Methods
3 studies were performed: A1, A2, and B, with details as follows: A1) Touch contamination at the transfer set connector adapter (TSCA) and the patient connector adapter (PCA) ends, each connector quantified. A2) Touch contamination simulated as in A1, connected and flushed to quantify the bacteria transferred into the fluid path. B) Known levels of bacterial contamination were inoculated into the fluid path, performed CAPD procedure and quantified the patient infusion fluid. Three different commercially available PD delivery systems (System 1, 2, 3) were tested using the above (27 times over a 4 day period) that differed in location of the frangible, the Y-configuration and the size of the shrouds (short: Camex; long: Hytrel) on the PCA.
Results
For touch contamination evaluation (A1), the TSCA had a significant (p-values <0.0001) lower mean bacterial level compared to the PCA. For touch contamination evaluation (A2), system 2 had a significantly higher mean count than systems 1 and 3 (p-value <0.001). For the flush efficiency evaluation (B), the three systems were compared within each day. There were no significant differences in the mean log base 10 values among the three systems within days 1, 3 and 4 (p-values ≥0.05). For day 2, system 3 mean was significantly higher than system 2 mean (p-value = 0.0031).
Conclusion
Touch contamination studies show that when contaminated, the smaller surface area of the TSCA when compared to the PCA resulted in lower bacterial counts. Despite what would appear as a more protective design, the deeply recessed Hytrel shroud resulted in significantly higher bacterial transfer into the fluid path than the shallow recessed Camex shroud. These differences are immaterial given no difference between “Flush before Fill” efficiency of the 3 systems, irrespective of frangible location or asymmetric Y position. This highlights the importance of redundancy in connection design features to reduce PD touch contamination.