If you are setting up a new dialysis clinic, or just revising internal guidelines, this may help you to understand the full process, and become more familiar with water treatment in the dialysis clinic.
Check the incoming water source
Your clinic’s water source should be tested periodically to make sure that the level of chemical contamination meets AAMI (Association for the Advancement of Medical Instrumentation) standards. Send a sample of your water to a qualified lab that can analyze the samples according to AAMI standards. Since dialysis clinics are required to meet AAMI standards at all times, you should check the water about every quarter to ensure that you are meeting AAMI standards. Samples for product water chemical analysis should be drawn from a sample port immediately after the RO or DI system. You can then determine if your water filtration system is degrading, or if there are changes to the incoming source based on past analysis trends.
When and Where to Test the Water:
When collecting samples from your water treatment system, be sure to run the water from sample ports for at least one minute at normal pressure and flow rate before collecting the water sample. Do not disinfect the sample port – this could lead to false readings. If you must disinfect, use alcohol instead of bleach, and only take a sample once the alcohol has completely dried. Use a reliable, accurate, and simple instrument to measure samples. If you do not already have an instrument, you can find some here that are designed specifically for dialysis clinics:
Proper Testing Protocol
To properly test the system, take samples from the product water distribution pipes at the following locations:
Site 1: Take a sample at the point where the water leaves the RO machine, before it enters the holding tank (Indirect System), or before it goes to the treatment room to provide water for dialysis machines (Direct System).
Site 2: If an RO water holding tank is present, take the sample at the point where the water leaves the tank.
Site 3: Take one at the end of the return line of the RO water distribution loop, whether it is returning to the RO or a water holding tank. If a bacteria filter is installed anywhere in the system, take samples from sample ports both pre and post filter.
Site 4: Take one at the point where water enters into the dialyzer reprocessing system, whether it is a manual or automated system. (Note: If a sample port is not present, install one.)
Site 5: Take one at a point where water enters equipment used to prepare bicarbonate and acid concentrate. (Note: If a sample port is not present one should be installed.)
Site 6: Take another at the point where the dialysis machine is hooked up to the product water loop. If a dialysis machine is consistently attached to that location, you may culture the machine instead of the water outlet.
Site 7: If your facility uses softened, dechlorinated water as a backup source, you must perform cultures and a Limulus Amebocyte Lysate (LAL) test on this water, because the RO is the primary source of bacterial protection for the patients.