Evaluation of hygiene monitoring methods for priming drainage lines in hemodialysis machines: a comparative experimental study

Background Hemodialysis patients face high infection risks, with the priming drainage line being a potential contamination source. This study evaluated the hygienic quality of priming drainage lines in dialysis machines after decontamination and compared adenosine triphosphate (ATP) bioluminescence with microbiological culture methods to identify a faster hygiene monitoring solution. Methods Surface samples from the priming drainage lines of nine dialysis machines were collected at three time points from three designated areas. Hygiene quality was assessed using aerobic colony count (ACC) and ATP bioluminescence methods, compared against internal benchmarks. A total of 162 samples were analyzed. Three disinfectants were used for surface disinfection: Clean Pon, Sun- joe, and Biorem- DL. Statistical analyses included the Kruskal–Wallis test for overall differences and the Dunn test for pairwise comparisons. Spearman’s rank correlation was applied to evaluate the relationship between colony-forming units (CFU) and relative light units (RLU) values. Results ACC and ATP levels varied significantly across areas and time points (p < 0.01), with area 3 showing the highest contamination. Disinfectants effectively reduced contamination at 12 h, though contamination levels tended to increase again by 18 h. Prior to decontamination, 25.9% of samples met the internal hygiene benchmark. At 12 h after decontamination, 81.5% of samples achieved the internal hygiene benchmark, which declined to 55.6% at 18 h. ACC and ATP results were moderately correlated (r = 0.55, p < 0.05). Clean Pon achieved significantly greater ACC reduction than Sun- joe (p < 0.05), while no significant differences were observed between Biorem- DL and the other disinfectants. ATP removal did not differ significantly among disinfectants. Conclusions Priming drainage lines were found to be contaminated with both bacteria and organic matter. Decontamination strategies should be tailored to disinfectant effectiveness and facility-specific conditions. ATP assays provide rapid screening for organic contamination but should be combined with microbiological monitoring for comprehensive hygiene evaluation. Trial registration This study did not involve human participants or health-related interventions and therefore was not subject to clinical trial registration requirements.