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Epidemic Parenteral Exposure to Volatile Sulfur-Containing Compounds at a Hemodialysis Center

Published online by Cambridge University Press:  02 January 2015

Dejana Selenic ,
Francisco Alvarado-Ramy ,
Mathew Arduino ,
Stacey Holt ,
Fred Cardinali ,
Benjamin Blount ,
Jeff Jarrett ,
Forrest Smith ,
Neil Altman  and
Charlotte Stahl
...Show all authors
Dejana Selenic
Affiliation:
Division of Healthcare Quality Promotion, National Center for Infectious Diseases, Atlanta, Georgia Epidemic Intelligence Service, Division of Applied Public Health Training, Epidemiology Program Office, Atlanta, Georgia
Francisco Alvarado-Ramy
Affiliation:
Division of Healthcare Quality Promotion, National Center for Infectious Diseases, Atlanta, Georgia Epidemic Intelligence Service, Division of Applied Public Health Training, Epidemiology Program Office, Atlanta, Georgia
Mathew Arduino
Affiliation:
Division of Healthcare Quality Promotion, National Center for Infectious Diseases, Atlanta, Georgia
Stacey Holt
Affiliation:
Division of Healthcare Quality Promotion, National Center for Infectious Diseases, Atlanta, Georgia
Fred Cardinali
Affiliation:
Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia
Benjamin Blount
Affiliation:
Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia
Jeff Jarrett
Affiliation:
Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia
Forrest Smith
Affiliation:
Ohio State Health Department, Columbus, Ohio
Neil Altman
Affiliation:
Youngstown City Health District, Youngstown, Ohio
Charlotte Stahl
Affiliation:
Youngstown City Health District, Youngstown, Ohio
Adelisa Panlilio
Affiliation:
Division of Healthcare Quality Promotion, National Center for Infectious Diseases, Atlanta, Georgia
Michele Pearson
Affiliation:
Division of Healthcare Quality Promotion, National Center for Infectious Diseases, Atlanta, Georgia
Jerome Tokars*
Affiliation:
Division of Healthcare Quality Promotion, National Center for Infectious Diseases, Atlanta, Georgia
*
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, 1600 Clifton Road, MS E-55, Atlanta, GA 30333
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Abstract

Objective:

To determine the cause of acute illness on August 30, 2000, among patients at an outpatient dialysis center (center A).

Design:

We performed a cohort study of all patients receiving dialysis on August 30, 2000; reviewed dialysis procedures; and analyzed dialysis water samples using microbiologic and chemical assays.

Setting:

Dialysis center (center A).

Patients:

A case-patient was defined as a patient who developed chills within 5 hours after starting hemodialysis at center A on August 30, 2000.

Results:

Sixteen (36%) of 44 patients at center A met the case definition. All case-patients were hospitalized; 2 died. Besides chills, 15 (94%) of the case-patients experienced nausea; 12 (75%), vomiting; and 4 (25%), fever. Illness was more frequent on the second than the first dialysis shift (16 of 20 vs 0 of 24, P < .001); no other risk factors were identified. The center's water treatment system had received inadequate maintenance and disinfection and a sulfurous odor was noted during sampling of the water from the reverse osmosis (RO) unit. The water had elevated bacterial counts. Volatile sulfur-containing compounds (ie, methanethiol, carbon disulfide, dimethyldisulfide, and sulfur dioxide) were detected by gas chromatography and mass spectrometry in 8 of 12 water samples from the RO unit and in 0 of 28 samples from other areas (P < .001). Results of tests for heavy metals and chloramines were within normal limits.

Conclusions:

Parenteral exposure to volatile sulfur-containing compounds, produced under anaerobic conditions in the RO unit, could have caused the outbreak. This investigation demonstrates the importance of appropriate disinfection and maintenance of water treatment systems in hemodialysis centers.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 25 , Issue 3 , March 2004 , pp. 256 - 261
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2004

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