Kubey W, Straka P, Holmes C
Effective titanium adapter disinfection for PD transfer set
change procedure
17th Annual CAPD Conference
Perit Dial Int Suppl 1
(Feb) 17:S75 1997
One of the potential peritonitis promoting factors may be a contaminated
titanium adapter if the junction between the adapter and transfer set
loosens and is retightened. In most centers an immediate external
disinfection of the transfer set-titanium adapter surfaces is done in such
circumstances, but might be ineffective.
To adress this issue, Kubey et al compared two methods of titanium adaptor
disinfection, as compared to the traditional 5 minute povidone-iodine soak.
In the first study, adapters were inoculated with S. aureus in 10% bovine
serum and air-dried to simulate the natural bioburden. Adapters sets were
then recapped with a povidone cap and two groups were created: one that had
the cap threaded by a single engagement, and the seocnd by means of
threading, loosening and rethreading to distribute the povidone more equaly
around the inoculated zone. In control group athere was a 5 minute soak in
povidone of the whole adapter. Then, the devices were placed in growth
media to assess efficacy of sterilization.
It appeared that 3/22 failed in the single engagement recapping group,
0/22 in the double engagement group, against 1/22 in the povidone soak
group.
A second study tested the double engagement method with a sample size of 59
and showed 3/59 failures in the cap procedure against 0/59 in the soak
procedure-group.
It is emphasized that the traditional soak method is the first choice
treatment of the titanium adaptor in case of loosening.
Comment: This interesting in vitro study shows us once more how
minimal quantities of microorganisms that survive on the surface of
devices pose a risk to the PD patient. Whether this experiment can be
extrapolated to an in vivo situation remains unclear, although this seems
likely. The advice to patients to use the soak method after retightening a
loosened adapter seems justified.
(Johan Rosman M.D., The Hague, Netherlands)
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17th Annual CAPD Conference
Basic peritoneal dialysis :
PD catheters
Basic peritoneal dialysis :
Peritonitis and exit-site infection