An in vitro Bacterial Touch Contamination Risk Assessment of Two CAPD Twinbag Systems

Abstract

The objective of this study was to compare, using in vitro quantitative microbiology, the ability of two commercially available peritoneal dialysis solution delivery systems to prevent and remove, via convective fluid flow, intralumenal fluid path bacterial contamination. The two systems (A and B) differed in both the configuration of their flow control, or Y-junction and the method of fluid flow control and also in the design of their Luer tubing connectors. System A had a tubing type Y-junction that requires clamps to control fluid flow and uses a connector with a male Luer that is deeply recessed within a shroud. System B has a dial-type rigid Y-junction with in-line flow control and a connector with a male Luer that is shrouded but not recessed. System A connectors allowed significantly (p < 0.0001) fewer bacteria to be transferred into the fluid path than System B after simulated touch contamination. Also, when an equivalent number of bacteria were deliberately placed into the fluid paths of both systems, System A was more effective in removal of the bacterial contamination by convective fluid flow than System B (p < 0.0001), resulting in fewer organisms infused into the simulated peritoneum. Specific design features of System A, such as a recessed male Luer, and a Y-junction fluid flow path with low turbulence were likely explanations for its superior results. This study emphasizes the importance of connector and fluid path flow design in the aseptic performance of peritoneal dialysis delivery systems.

A systematic review of peritoneal dialysis-related peritonitis rates over time from national or regional population-based registries and databases

“…PD transfer sets differ markedly between manufacturers, with studies consistently showing better elimination of potential bacterial contaminants by systems with controllers external to the flow path, rather than within the tubing. 43 A scoping systematic review by industry employees has shown that PD systems from different manufacturers have different PD peritonitis rates, 44 and this is a high priority for follow-through by independent investigators.…”

Relationship between Internet addictions and academic performance among Afghan universities students

“…Internet addiction is defined as, "an individual's inability to manage his or her use of the Internet, which finally results social, psychological, school, and/or work difficulties in a person's life" [20]. It is found that the university students may use the Internet addictively or Internet addiction adversely effects on individuals, physical health, family life, changing their social behavior, habits and abilities, and academic performance [6,14,[19][20][21][22][23]. In spite of the facts, Internet addiction was the first classified as a behavioral addiction and characterized as a form of cyber sexual addiction [24], cyber-relationship addiction [25], net compulsion [26], information overload [27], and addiction to interactive computer games [1,28].…”

In Vitro Microbiology Studies on a New Peritoneal Dialysis Connector

“…Our results show that none of the bacteria contaminating the pin were transferred to the fluid path, ruling out the possibility of bacteria gaining access to the peritoneum during PD fluid exchanges. These results are all the more impressive considering the level of contamination generated by the challenge procedures (1.6x10 5 CFU), which is considerably higher than might be expected in the clinical setting—from 10 2 CFU by unprepared hands, up to 4.5x10 3 CFU if hands are washed but not dried (22)—or than has been reported as the worst-case touch contamination scenario in previous studies (23-25) evaluating the ability of several commercially available PD connectors to prevent fluid path contamination (Table 1).…”

“…32, NO. 5 PDI (22)-or than has been reported as the worst-case touch contamination scenario in previous studies (23)(24)(25) evaluating the ability of several commercially available PD connectors to prevent fluid path contamination (Table 1).…”

“…It is important to note that, although the CRM device can also operate the flush-before-fill step, we simulated PD exchange in the present study without including that step. Without such convective removal of bacteria contaminating the fluid path, commercially available connector systems would not be very efficient in reducing bacterial contamination (23,25).…”