Medical Center Dialysis Department gets boost

In an effort to provide better dialysis care to its growing number of patients, the St. Maarten Medical Center (SMMC) has embarked on an initiative to better its Dialysis Department with new equipment and employee training.

SMMC has invested in a new and more advanced Reverse Osmosis (RO) water purification system which is critical for the dialyzing process and will be replacing all of its dialysis machines with new and modern ones.

Once completed SMMC will have a total of 12 dialysis machines - 10 in service and two backup ones. The total investment will be US $500,000 Human Resources/Communications Manager Juliëtte Hassell told Health Update.

The RO water purification system was installed at the end of June 2011. The replacing of the dialysis machines will be done in phases as the department still needs to be operational. Four new machines were already installed in the week of January 9 and the remaining will be installed in increments of four every three months this year. "The new dialysis machines are sophisticated and modern. They also have more features and for a more effective dialysis of patients," says Dialysis Department Supervisor Anita Rotsburg.

Dialysis

Dialysis is critical for persons with kidney disease. The kidneys, two organs located on either side of your spine just above the waist, perform several life-sustaining roles. They cleanse your blood by removing waste and excess fluid, maintain the balance of salt and minerals in your blood, and help regulate blood pressure.

When the kidneys become damaged, waste products and fluid can build up in the body, causing swelling in your ankles, vomiting, weakness, poor sleep, and shortness of breath. If left untreated, diseased kidneys may eventually stop functioning completely. Loss of kidney function is a serious - potentially fatal - condition.

Each bean-shaped kidney is 4 to 5 inches long and contains about a million nephrons, which are like tiny pouches. Each nephron has a filter at one end, called a glomerulus, to filter your blood. These do no function in a person with kidney disease.

Why a new water system?

During dialysis, water in large amounts (almost 50 times the normal exposure experienced by healthy people) bypasses the normal protective mechanisms of the gastrointestinal tract and is in nearly direct contact with the patient's blood (separated by only the thin semi permeable membrane of the dialyzer). It is therefore critical that the quality of the water used to prepare dialysate be carefully monitored and accurately controlled.

A good functioning water purification system is therefore critical to the dialysis treatment process. For each dialysis treatment, water is mixed with dialysate concentrate to form the dialysate, which then helps transport metabolic waste and excess fluids from the blood stream of a patient with compromised kidney function. Because the kidneys no longer can filter on their own, if any contaminate is left in the water, then the patient is at risk from many complications, including death.

SMMC's new RO water treatment system is called 'Aquaboss.' This system has a number of advantages: Due to its easy use the nurses will be able to quicker connect you to the dialysis system; the system uses a heat disinfection method, in line with the latest developments in purification systems. This method lessens the chance of bacteria growth which means less down time for cleaning. The system also requires significant less maintenance which will translate in more reliable service to you. The system will allow us to use up to 80 per cent less water. The installation took place during the evening and night hours to minimize any impact on the comfort of patients.

The previous system had a capacity to operate ten dialysis machines at any given time. The new system can accommodate up to 25 machines at any given time. This means that SMMC will be able to expand its Dialysis Department to up to 25 machines in the future if it so desires. The RO system alone costs about US $ $170,000. "We needed the new system because of the growth of department, but also for its efficiency," said Rotsburg.

Rotsburg said the department had been encountering a lot of challenges with the old equipment, which had in service for about six years, breaking down. Sometimes to maintain them, a technician had to be brought in from Brazil.

Anguilla, Aruba and Curacao currently use the same machines as the new ones being used by SMMC. This means that if needed, technicians can be brought in from one of these destinations.

Representatives of the manufacturers provided training to the Dialysis Department staff on the use of the new dialysis machines. More training will be provided in the future.

Growth:

SMMC's Dialysis Department has grown significantly over the years with more and more patients from St. Maarten and neighbouring islands dialyzing. An average of 20 patients per day dialyze at SMMC.

Rotsburg says when she started working at SMMC in 1993 there were 11 dialysis patients. Today, there are 38 from St. Maarten, Saba and Statia.

Additionally, on a regular basis cruise ship and stay over tourists also make use of the facilities. Due to the sensitiveness of the dialyzing process, a strict protocol is involved when accepting new dialysis patients.

New patients, such as tourists, are required to inform SMMC at least three months in advance that they will be using the services here. This is required to, among other things; obtain necessary medical data as well as to ensure that the patient does not have any communicable diseases such as MRSA which can be dangerous in a hospital environment Hassell and Rotsburg said.

MRSA, or methicillin-resistant Staphylococcus aureus, is caused by a staph infection that is becoming increasingly resistant to antibiotics. It used to be that such infections could be successfully treated with penicillin. However, as antibiotic use rose over the years, the so-called 'bugs' that antibiotics were used to eradicate have become increasingly resistant.

These "superbugs" can live on and be passed onto patients via hospital gowns worn by doctors and nurses. As well, a patient who occupies a hospital room recently vacated by a patient with an MRSA superbug runs the risk of becoming infected unless the room is thoroughly sanitized—including the floor. The MRSA superbug can also be passed on to others from contact with the skin.

A patient with MRSA is dialyzed in an isolated environment while being treated to prevent spread of the virus.

With the growth in the number of dialysis patients at SMMC, Rotsburg and Hassell highlighted the need for preventative care. Like in Latin American and other parts of the Caribbean diabetes and hypertension are the leading causes of kidney disease in St. Maarten, Saba and Staita.

Costly

Dialyzing is a costly process. It is covered by Social and Health Insurance SZV; however the cost of the uninsured can be high. It costs US $435 per dialysis treatment. This cost can run as much as US $700 – 800 if medication is taken into consideration.

SMMC's Dialysis Department has 13 staffers – the department head, eight specialized dialysis nurses and four dialysis assistants who help nurses.

In addition to upgrading its equipment, the Dialysis Department also works towards promoting the comfort of patients, who spend up to five hours for each dialysis treatment two to three times per week. Last Christmas for example, the staff held a Christmas party for patients at the WIFOL building on the Walter Nisbeth Road (Pondfill Road). It is their intention to do more to make patients feel more comfortable during their lengthy stay at the hospital.

"The dialysis department is a bit different from other departments. You build up a bond with patients because they need to be here so often," said Hassell.