Abstract

The 'Y' set introduced in the clinical practice in the early 80s with the aim of reducing the peritonitis rate in patients on continuous ambulatory peritoneal dialysis, successfully rev-olutioned the philosophy of the connection system catheter-container of dialysate, which was the main way of bacterial contamination of the peritoneal cavity. In fact, while the previous connection systems had focused the attention on the reduction of the possible contaminating acts, the 'Y' system, taking into...

References

1 Beathard GA Improving dialysis vascular access. Dial Transplant 2002 31 210-219. 2 Ifudu O, Mayers JD, Cohen LS, Paul H, Brezsnyak WF, Avram MM, Herman AI, Friedman EA Correlates of vascular access and nonvascular access-related hospitalizations in hemodialysis patients. Am J Nephrol 1996 16 118-123. 3 Di Iorio B, Bellizzi V, Cillo N, Cirillo M, Avella F, Andreucci VE, De Santo NG Vascular access for hemodialysis the impact on morbidity and mortality. J Nephrol 2004 17 19-25. 4 David A,...

Contents

Ronco, C. (Vicenza) Mishkin, G.J. (Gaithersburg, Md.) Bianchi, P. Buoncristiani, E. Buoncristiani, U. (Perugia) 7 Sodium Hypochlorite History, Properties, Electrochemical Production 24 Toxicity and Safety of Topical Sodium Hypochlorite 39 Disinfection of Dialysis Monitors Ghezzi, P.M. (Montemassi) Bonello, M. (Anagni) Ronco, C. (Vicenza) Cappelli, G. Ricardi, M. Ravera, F. Ligabue, G. Ballestri, M. Bonucchi, D. Bondi, M. (Modena) 72 Compatibility of Electrolytically Produced Sodium Hypochlorite...

Methods

Application of Amuchina packs for different germs Table 2. Application of Amuchina packs for different germs Amuchina (sodium hypochlorite) packs that were left in place for 3-5 min each day for 2 weeks. Every day the dressing was prepared with iodine pack (table 2). In the period 2004-2005, 15 patients contracted infection of exit-site. All patients underwent a swab test because of the reddening and the purulent secretion of the exit-site discovered at the physical examination. The...

Discussion

Our study shows that Amuchina is effective in the prevention of exit-site infection during the 14 months of the study, seventeen times more than pH neutral soap. With very similar groups, in age, and time on dialysis, when is compared the Amuchina group with the soap group, the OR 17, shows the safety of using the chloroxidizer, which is statistically significant (p 0.004). There are some items to be observed, such as all children took care of their own exit-sites. Somehow it is surprising that...

Sodium Hypochlorite

The advantages for using sodium hypochlorite compared to povidone-iodine are listed in table 2. There are, however, arguments against the use of sodium hypochlorite as a disinfectant. One of the main concerns is the consequence of accidental intra-peritoneal infusion of sodium hypochlorite. The rate of accidental infusion of sodium hypochlorite ranged from one in 2,500 exchanges in the Canadian CAPD Clinical Trials Group 4 to one in 8,000 exchanges 12 . Immediate painful chemical peritonitis...

External Disinfection of Dialysis Monitors

Disinfection of the hydraulic circuits of the dialysis monitors is not the sole procedure capable of guaranteeing maximum security it is also necessary to carry out a thorough cleansing and disinfection of the external parts of the equipment before starting another dialysis session. A correct procedure includes the operators (clothing, maneuvers, instruments) and the environment (from the dialysis room to the furnishing). Having a correctly disinfected monitor in its internal components, but...

Carcinogenicity Mutagenicity Studies

The toxicity and carcinogenicity of sodium hypochlorite has been examined extensively. Both published and unpublished studies have repeatedly demonstrated this ingredient's safety, and failed to raise any significant questions regarding acute toxicity or carcinogenicity. A number of studies that examine sodium hypochlorite's carcinogenic and mutagenic potential have been investigated by both in vitro and in vivo methods. One of the most common worldwide uses of chlorine and chlorine containing...

Peritoneal Dialysis

Therefore, it is easily understandable why the problem of prevention and therapy of infectious complications in patients on CAPD has attracted a lot of interest, due to the high, direct risk of infections intrinsic in this treatment. As far as the prevention of peritonitis is concerned, consideration has been reserved to chemical agents (antisepsis). Their use has been proposed and in some extent applied in order to try to kill the micro-organisms possibly contaminating the distal end of the...

Objective

Until now, there have been few studies published about Amuchina and the exit-site infection prevention measure on children with PD. The aim of the study is to compare the efficacy of Amuchina against pH neutral soap on prevention of exit-site infected children with Tenckhoff catheter for cyclic continuous PD. The incidence of Tenckhoff catheter's exit-site infection, is 1 per month in our hospital, to measure the efficacy of Amuchina, we hope to reduce this by 50 of the annual incidence.

Human Sensitization and Irritation Tests

The fact that sodium hypochlorite is not a sensitizer is a significant advantage that sodium hypochlorite solutions have over some other topical antiseptics. To clarify sensitization potential, Hazelton Laboratories examined 1.1 sodium hypochlorite solution using a standard test for predicting sensitization or allergic reactions, the Guinea Pig Maximization Test 46 . This test consisted of dermal and intradermal application of various concentrations of test solutions of sodium hypochlorite as...

Background

Continuous ambulatory peritoneal dialysis (CAPD) has been the first-choice treatment for ESRD in Mexico for the last 25 years. Eighty-five percent of the Mexican dialysis population are currently on this modality 1 . Peritonitis is the most frequent cause of morbidity and is among the leading causes of technique failure in our country 2, 3 . Also, it is an important barrier to long-term CAPD in developing countries 4, 5 . Attempts to decrease infection rates in CAPD have included eradication of...

Biofilm and Medical Devices

Microorganisms in a sessile phase exhibit a distinct phenotype with respect to gene transcription, growth rate and ability to resist antimicrobial or Table 1. Medical devices associated with biofilm infections Arterial catheters Spinal implants Pulmonary artery catheters Penile implants Umbilical catheters Breast implants Peritoneal dialysis catheters Orthopedic prostheses Urinary catheters Cochlear implants Nasogastric tubes Neurosurgical stimulators Gastrostomy tubes Middle ear implants...

Central Venous Catheters

Tunneled, cuffed catheters were developed in 1987 3 . Since their inception, CVCs have become an access of convenience easily inserted and available for use within minutes. Maturation or healing time is not necessary rather, these devices may be used immediately after radiological verification. They are inserted into deep veins such as the jugular, subclavian, or femoral veins and are advanced into the vena cava. They may be placed percutaneously at the bedside thereby eliminating the need for...

Complications of Central Venous Catheters

Procedure related complications of CVCs occur in approximately 7 of cases and include pneumothorax, hemothorax, air embolism, and procedure-induced sepsis 2 . Long-term complications, however, contribute to high mortality rates in this patient population 7 . They include thrombosis, stenosis, occlusion, and infection. Thrombosis may occur as a result of tissue trauma at the time of catheter placement. Any disruption in the endothelium triggers a change in the blood flow, the vessel wall and...

Dedication

Amuchina's history has been part of my family for over 50 years. My grandfather Pietro bought Amuchina Company from Eridania, a large Italian sugar company, in 1948. My grandfather Pietro and my father Giorgio spent all their work and energy to improve and promote the use of Amuchina as an antiseptic and a disinfectant. Since then our mission has been the prevention of infections. After so many years of activity, we can surely say their goals were achieved. They were always convinced of the...

Exit Site Care Pre Implantation of PD Catheter

The exit-site should be identified and marked on the skin. This should be done in collaboration with the patient, the surgeon, the nephrologist, and the experienced PD nurse. The exit-site should be placed laterally either above or below the belt line, and it should not lie on a scar or in abdominal folds. It should be determined with the patient in an upright (seated or standing) position. Local trauma and hematoma during catheter placement should be avoided. The exit-site should be round and...

Infection

The literature has reviewed a number of preventative strategies employed to reduce catheter-related infection. They include low nurse-patient ratio, maximal sterile barriers, use of topical ointments, appropriate catheter dressings, and type of skin antiseptics. The literature appears to be consistent in its support of an educational program and or specialized team of individuals dedicated to the care of intravascular devices 15, 24, 25 . In a cohort study of surgical intensive care unit...

Preface

Sodium hypochlorite has long been recognized for its effectiveness as an antiseptic and disinfectant. In his historic pioneering work, in which he proved in a convincing clinical trial the importance of hand disinfection, Semmelweis used sodium hypochlorite as a hand wash and disinfectant to reduce mortality from childbed fever 1 . In another historic discovery, Carrel and Dakin introduced 0.45-0.5 buffered sodium hypochlorite for the treatment of trauma wounds during the First World War 2, 3 ....

The Perugia YSet with Disinfectant

The search for a new connection system for CAPD started from the consideration that in the system proposed by Oreopoulos et al. there was no possibility to remove the bacteria after the possible contamination of the connection and before the filling of the abdomen and that, as a consequence, the only way to reduce the peritonitis rate was the accurate and paroxysmal prevention of the contamination 9 , because, once this had occurred, peritonitis was almost unavoidable. But, sooner or later,...

Disinfection of the Transfer Set during a Change

The transfer set reduces mechanical malfunction due to normal wear and tear from stress or manipulation to the chronic PD catheter. The transfer set is changed every 6-9 months to reduce infection rate. When the transfer set is separated from the chronic PD catheter, the catheter with or without the adaptor is soaked in disinfectant to reduce infection complications. Disinfectants that are popularly used are povidone-iodine or sodium hypochlorite and will be compared for efficacy and side...

Extra Corporeal Dialysis

Other than Peritoneal Dialysis, electrolytic chloroxidizer is used as well in extra-corporeal dialysis. Because of the fact that the dialytic circuit is considered an extension of the blood circuit of the patient, it is imperative to adopt universal precautions in order to avoid potential transmission of infections. In chemical disinfection, the requirements for dialysis monitors disinfections are activity versus bacteria, viruses, fungus and protozoa capability to reduce pyrogens capability to...

Chronic Exit Site Care of Healed Exit Site

Although sterile dressings are recommended until the exit is well-healed, there is no clear consensus as to when patients may begin to shower or change to chronic exit-site care. When the exit-site can be classified as good or equivocal, then showering and chronic care are appropriate 10 . The primary goal of exit-site care is to prevent ESIs and TIs. Exit-site care should include (1) assessment of the exit-site (2) cleansing the exit-site (3) anchoring or immobilizing the catheter and (4)...

Historical Use of Sodium Hypochlorite

The history of the use of hypochlorite as a disinfectant and antiseptic goes back hundreds of years. It was used for the treatment of wounds and burns even before the revolutionary work of Lister and Koch. Among early uses, the Marquis de la Motte used a hypochlorite solution for the treatment of gangrene in 1732 1 and Paris surgeons used it for the treatment of burns, operative wounds, and ulcers 1 . As noted in the background section, Semmelweis used hypochlorite as an antiseptic hand wash to...

Disinfection of Disposable Dialysis Tubing

The rate of continuous cycler PD use in the hospital setting is increasing. Using a cycler frees up the nurse's time. Instead of performing 4-8 manual exchanges per day, the nurse can put up enough dialysate for a day with one connection to initiate the cycle and one disconnection to terminate the cycle. Infection rate decreases due to fewer connect disconnect procedures where touch contamination is possible. The patient can be disconnected for procedures and then reconnected to the same line....

Biofilm and Disinfection in Dialysis

Disinfection enters the quality assurance program in dialysis and represents part of the various anti-inflammatory treatment strategies adopted to improve outcome in these patients. Several liquid chemical germicides or physical disinfectant techniques are commercially available and choice is based not only on effectiveness but also Fig. 1. Subsequent phases of biofilm formation with bacterial deposition a , attachment b , growing c up to a mature biofilm d onto a silicone tube from a dialysis...