부산대학교 도서관

AbstractObjectve:To determine the cause of clustered bacteremias occurring among chronic hemodialysis patients.Design:A retrospective investigation of clinical and laboratory records with direct observation of dialysis facilities and technique. Bacterial blood isolates were identified and compared with environmental isolates.Setting:The 1 1-station chronic hemodialysis unit that serves approximately 50 patients in a 450-bed military hospital.Patients:Hemodialysis unit patients with aerobic gram-negative bacillus or Enterococcus casseliflavusblood isolates between April 1988 and February 1990.Results:The recovery and species identification of the unique isolate, E casseliflavus, from 2 index cases of bacteremia in February 1990 helped identify the cluster and demonstrated its protracted course. Dialysis blood tubing was contaminated with ultrafiltrate waste during dialyzer setup.Intervention:Bacteremias were controlled by halting the practice of attaching the venous tubing directly to a waste container while priming the membrane, by emphasizing glove changes and handwashing after contact with ultrafiltrate waste and by daily decontamination of ultrafiltrate waste bags.Conclusions:We recommend that other hemodialysis units institute these interventions.