During the period from April 4, 1988, to April 20, 1988, nine pyrogenic reactions and five gram-negative
bacteremias occurred in 11 patients undergoing dialysis. All pyrogenic reactions and gram-negative
bacteremias occurred among patients in whom a reprocessed dialyzer was used. The rate of pyrogenic reactions or
bacteremias per 100 sessions using a reprocessed dialyzer was higher than in sessions during which a new dialyzer was used (4.5 vs. 0; p = 0.03). Dialyzers were manually reprocessed with 2.5%
Renalin germicide. The
Renalin concentrations varied widely in 12 dialyzers stored after manual reprocessing during the epidemic period (0.9-4.2%); the median
endotoxin concentrations varied from 0 to 246 ng/ml and were higher in dialyzers with
Renalin concentrations less than or equal to 1.0% than in dialyzers with higher concentrations (p = 0.01). Experiments using a dilution technique described by a technician resulted in
Renalin concentrations ranging from 1.4% at the surface to 3.5% at the bottom of the preparation container. These findings suggest that failure to adequately admix
Renalin during dilution may be associated with low levels of
disinfectant, high levels of bacteria and
endotoxins in dialyzers, and outbreaks of pyrogenic reactions and gram-negative
bacteremias in dialysis patients.