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MAY, 2008
Issue:14
People in low-resource countries who are ill with multidrug-resistant TB (MDR-TB) will get a faster diagnosis -- in two days, not the standard two to three months -- and appropriate treatment thanks to two new initiatives unveiled today by WHO, the Stop TB Partnership, UNITAID and the Foundation for Innovative New Diagnostics (FIND). MDR-TB is a form of TB that responds poorly to standard treatment because of resistance to the firstline drugs isoniazid and rifampicin. At present it is estimated that only 2% of MDR-TB cases worldwide are being diagnosed and treated appropriately, mainly because of inadequate laboratory services. The initiatives announced today should increase that proportion at least seven-fold over the next four years, to 15% or more. "I am delighted that this initiative will improve both the technology needed to diagnose TB quickly, and increase the availability of drugs to treat highly resistant TB," said British Prime Minister Gordon Brown, who helped launch the Stop TB Partnership's Global Plan to Stop TB in 2006 and whose government is a founding member of UNITAID. "The UK is committed to stopping TB around the world, from our funding of TB prevention programmes in poor countries, to our support of cutting edge research to develop new drugs."
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WASH Reducing salt intake from the current worldwide intake of 10-15 g/day to a maximum of 5-6 g/day could potentially prevent 24% of strokes and eliminate 18% of deaths from cardiovascular disease—clearly an enormous health benefit from a very small change in an individual's eating habits. However, in most countries approximately 80% of a person's salt intake comes from processed and catered foods, the salt content of which is usually very high—something the consumer probably is unaware of, and at any rate she or he has no control over. Studies by the World Health Organization have shown that reducing population salt intake by reducing salt in processed and catered foods is one of the most cost effective strategies for improving health. It also has the added benefit that it does not require a change in consumer behavior. WASH (World Action on Salt and Health) is a global group working to reduce salt in the diet worldwide by exerting pressure on multi-national food companies to reduce the salt content of their products and by advocating for government policies on salt reduction. The goal of World Salt Awareness week was reduce the amount of salt consumed by children by increasing awareness that children should eat less salt than adults and provide practical information on how to reduce the level of salt that children eat. Posters and booklets with useful information for parents and providers can be downloaded from the WASH website (w). A newsletter and evaluation report of the first World Salt Awareness Week are also available online. Links are provided to additional resources and relevant websites.
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NEW RAPID TESTS FOR DRUG-RESISTDIALYSIS PATIENTS AND DIET ANT TB IN DEVELOPING COUNTRIES
REPROCESSING OF DIALYZER
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Hon. Editor: Prof. K.V. Dakshina Murthy M.D D.M NIMS, Hyderabad
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5 REPROCESSING OF DIALYZER The past decade has seen marked improvement in the quality of dialysis treatment of patients with ESRD . The decreased mortality rate is probably the result of a no of factors including understanding of the rule of comorbidity , treatement unit characteristics,barriers to adequate dialysis ,nutrition ,anemia,low flux dialysis and dialyzer membrane improvement and the desired dialysis dose. During this same period of time, automated dialyser reprocessing has increased steadily all over. Manual dialyser reuse has been practiced since the beginning of chronic haemodialysis, initially because of the economic savings associated with dialyzer reuse and later because of improved patient responses to dialysis with reprocessed dialyzers. and mainly we can avoid the first use syndrome with the cellulose dialyzers after doing reuse. Despite manufacturer introduction of less expensive dialyzers labeled for single use. By 1997 dialyser reuse was practiced in 82% of dialysis centers. If dialyzers are not going to be reprocessed within two hours of completion of treatment, then they must be refrigerated for not more than 36 hours to slow bacterial growth After returning the patient’s blood with normal saline, heparinize the remaining saline index in extracorporeal circuit to recirculate for one to two minutes at 300 blood flow. We cap the dialyzers and thus dialysate ports. Make sure the blood compartment is fluid filled and no air has been introduced into the dialyzer, and return the dialyzer to the reuse room.
Reuse is safe and effective if performed correctly. You will hear that statement from anyone who does reuse and anyone who talks about reuse. We just looked at a number of ways that it can be done improperly. Reuse is an acceptable practice to save money and provide the patient with the best of care. If you save money, you can increase the quality of the treatment you give the patient by getting better dialyzers and doing better things for the patients
World wide reuse
Process is going on
Automated Procedure:
Automated dialyzer reprocessing machine
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Automated reprocessing is utilized by over 60%of the centers practicing dialyser reuse. Dialysis care providersand their management teams are faced with the task of impoving the quality of patient care while maintaining and redusing the cost of care. It decreases the hazardous to the dialyser reuse personnel and it avoid blood leaks with reuse dialyzers by doing pressure tests.
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6 Automated reuse: Renatron The Renatron is a single-station machine, modular up to six machines. It uses Renalin only. It has a computerized database and 8 to 10 minutes per dialyzer; pressure and volume tests only. Automated reuse: Seratronics DRS4 Automated machines-I will start off with the Seratronics DRS4. That is a four-station machine, approximately 35 minutes for four dialyzers. Cleaning agent can take multiple cleaning agents, not at the same time. Obviously you set your machine up for the one that you’ve chosen. The disinfectantsthe same thing. Computerized database. And it has the pressure, the volume, and ultrafiltration rate tests.
Cleaning: After giving water wash in the blood compartment ,close one end of dialyser port and give presurised (20 psi)rinse from one end for 10 min , this technique removes blood stains from internal side and improve no of reuses.
Automated reuse: Mesa medical - Echo The Mesa medical’s - Echo is a single station. The cleaning agent is multiple disinfectant as well as multiple. There is no database. Eight to 30 minutes per dialyzer, and does pressure and volume tests only. Cleaning: Hydrogen peroxide/peracetic acid Hydrogen peroxide, peracetic acid, does not remove proteins; ultrafiltration decreases; clearance of middle molecules significantly reduced in certain dialyzers. REUSE CALCULATIONS The average reuse no for dialysers were calculated in two ways
Formula: I ( no of resuse dialysers discarded )
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“ ( no of reuses per dialyser discarded in the month )
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Cleaning: Depyrogenated RO water Depyrogenated RO water used alone is very cheap, it is nontoxic, and very effective when used with reverse ultrafiltration.
The conventional method :This method is calculated by determining the mean of no of dialysis treatments performed with a discarded dialyser for a given month.
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( no of reuse treatments per month ) no of reuse dialysers discarded New technical practices to improve no of reuses : ◆
Standardize heparin stoppage 30 min before treatment end before it is 60 min
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Prime the dialyzer with 1000IU/l normal saline before it is 500IU/l
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Raise the venous end up during recirculation
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Standardize administration of heparin loading dose before initiating treatment
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Avoid air returning of blood
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Recirculation of heparenized (1000IU) saline at the end of treatment for 5-10 min flow rate of 350-400ml/min
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Maintain current practice
Advantages of reuse The advantage of reuse is decreased treatment costs. We are seeing some of our clinics now moving to nonreuse with the advent of the low-cost dialyzers, such as the F6. But obviously with clinics that are using the more expensive F80 dialyzers, reuse is very much effective. It just doesn’t make economical sense to go to non-reuse and having half the patients using F80s. It would cost them too much money to do that. We can have shorter treatment times by using the highflux dialyzers, improved biocompatibility and reduction of first-use syndrome. Disadvantages of reuse Patient and staff exposure to toxic chemicals when using formaldehyde, Renalin, glutaraldehyde… there is potential bacterial endotoxin contamination of the
Conclusion So the conclusions we come to with our reuse programs: Reuse can be performed safely with established written of protocols, following the recommendations of the dialyzer and germicide manufacturer, the Association for the Advanced Medical Instrumentation - that’s AAMI, the National Association of Nephrology Technicians-NANT, and the Center for Disease Control-the CDC in Atlanta.
Reuse is a difficult balance of risks and benefits. It provides significant economic benefits to dialysis providers and allows the use of expensive high-flux/high-efficiency dialyzers routinely. Hari.Ragi Dialysis Tech , Dr. sham sunder HOD Nephrology Dr. RML Hospital NewDelhi. hariragi@yahoo.co.in / gmail.com Cell No:09868633506
Please Answer the following Questions. Kindly hand over answer to Dr. Reddys - Futura Officers or Post to D-Tech. 1. Name the factors which led to Dialyzer reuse 2. What is percentage reuse world wide in 2003 3. Name 3 automated systems used 4. Mention 3 Advantages of dialyzer reuse. 5. Name 2 formulas for reuse calculations.
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Formula: II
dialyzers if the guidelines are not followed. Changing in dialyzer clearance, change in dialyzer ultrafiltration rate, and the potential for crosscontamination is always there.
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The Hart line method: This method is calculated by divided total no of treatments by the no of reuse dialysers discarded for the month
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