Bacterial contamination of hemodialysis water in three randomly selected centers in South Western Nigeria

Background: Hemodialysis (HD) is the most common method of renal replacement therapy for patients with either acute kidney injury in the failure stage or end stage kidney failure in Nigeria. The number of dialysis centers in Nigeria has risen exponentially from 10 centers two decades ago to more than 120 centers in 2015. The number of patients needing renal replacement therapy in the country in the form of HD has also risen close to a projected 2000/year. The outcome from HD in Nigeria is poor as a result of a myriad of interwoven factors such as complications of cardiovascular diseases and suboptimal dialysis dose primarily due to economic factors. These are often complicated by episodes of dialysis water related bacteremia, possibly as a result of the apparent lack of a standardized guideline or protocol for monitoring dialysis water treatment system which is the driving force of dialysis units. Objectives: This is a multicenter laboratory-based study designed to determine the microbiological quality of samples of HD water and dialysate in randomly selected dialysis units in three major government teaching hospitals in Nigeria. Methodology: Water samples were aseptically and serially collected from three HD units. The samples were taken from 6 points at each center coded A, B, and C over a 6-month period. Results: The water system in the three dialysis centers were grossly contaminated with Gram-negative aerobic bacteria such as Pseudomonas species and Moraxella species at all the points in the three centers. Conclusion: Conventionally, water treatment is a major determinant of morbidity and mortality in HD units, and the microbial quality is a major factor involved. There is evidence of bacterial contamination in the dialysis units sampled in this study. There is thus the compelling need for periodic microbiological monitoring of water after each treatment step. A uniform national guideline as part of an effective quality assurance protocol in infection surveillance is also advocated for dialysis units in Nigeria.