Marion K et al. (2005) A new procedure allowing the complete removal and prevention of hemodialysis biofilms. Blood Purif 23: 339–348

Total detachment and elimination of BIOFILMS from the inner surface of the tubing of hemodialysis machines is vital for patient safety. Current cleaning procedures use disinfectants. These agents destroy bacteria but dead cells remain, encouraging regrowth of biofilm, production of PYROGENS and development of infections. Now, researchers have developed and validated a new procedure called Pronetron® (Kazieltys Laboratoire, Lyon, France), which combines synergistic products for optimal efficacy.

Pronetron® involves the application of an alkaline detergent after each dialysis session to prevent adherence of most cells and, as a corrective measure every 3–6 months, sequential treatment with a multi-enzymatic mixture and stronger detergent solution to remove accumulated biofilm.

The procedure was tested in both an in vitro biofilm model and a working dialysis machine. In all studies, both the preventive and corrective regimens dramatically reduced biofilm coverage, culturable bacteria counts and endotoxin levels compared with untreated controls. The detergent/enzyme treatment even eradicated bacterial colonizations greater than 108 CFU/cm2 that developed after use of contaminated dialysate. By contrast, conventional disinfectants—peroxyacetic acid and citric acid—left 50% biofilm coverage inside some tubing samples.

As Pronetron® leaves no viable cells attached to dialysis tubing, the development of bacterial resistance is unlikely. Other advantages are time-efficiency and lack of odor, plus a non-corrosive and minimally toxic profile.