Original Article

Evaluation of Bacteriological and Chemical Quality of Dialysis Water and Fluid in Isfahan, Central Iran

Abstract

Background: Chemical and microbial quality of water used in hemodialysis play key roles in a number of dialysis-related complications. In order to avoid the complications and to guarantee safety and health of patients therefore, vigorous control of water quality is essential. The objective of present study was to investigate the chemical and bacteriological characteristics of water used in dialysis centers of five hospitals in Isfahan, central Iran.

Methods: A total of 30 water samples from the input of dialysis purification system and dialysis water were analyzed for chemical parameters. Heterotrophic plate count and endotoxin concentration of drinking water, dialysis water and dialysis fluid of 40 machines were also monitored over a 5-month period in 2011-2012.

Results: Concentration of the determined chemicals (copper, zinc, sulfate, fluoride, chloramines and free chlorine) did not exceed the recommended concentration by the Association for the Advancement of Medical Instrumentation (AAMI) exclude lead, nitrate, aluminum and calcium. Furthermore, the magnesium; cadmium and chromium concentration exceeded the maximum level in some centers. No contamination with heterotrophic bacteria was observed in all samples, while the AMMI standard for endotoxin level in dialysis fluid (<2 EU/ml) was achieved in 95% of samples.

Conclusion: Dialysis water and fluid failed to meet the all chemical and bacteriological requirements for hemodialysis. To minimize the risk of contaminants for hemodialysis patients therefore, a water quality management program including monitoring, maintenance and development of water treatment system in hemodialysis centers is extremely important. In addition, an appropriate disinfection program is needed to guarantee better control of bacterial growth and biofilm formation.

 

 

Kashiwagi T, Sato K, Kawakami S, Kiyomoto M, Takei H, Suzuki T, Genei H, Nakata H, Iino Y, Katayama Y (2011). The performance evaluation of endotoxin retentive filters in haemodialysis. J Nippon Med Sch, 78 (4): 214-223.

Ward RA (2007). Worldwide water standards for hemodialysis. Hemodial Int, 11 (s1): S18-S25.

Pontoriero G, Pozzoni P, Andrulli S, Locatelli F (2003). The quality of dialysis water. Nephrol Dial Transplant, 18 (Suppl 7): vii21-vii25.

Ahmad S (2005). Essentials of water treatment in hemodialysis. Hemodial Int, 9 (2): 127-134.

Bolasco P, Contu A, Meloni P, Vacca D, Murtas S (2012). The Evolution of Technological Strategies in the Prevention of Dialysis Water Pollution: Sixteen Years’ Experience. Blood Purif, 34 (3-4): 238-245.

Hoenich NA, Ronco C, Levin R (2005). The importance of water quality and haemodialysis fluid composition. Blood Purif, 24 (1): 11-18.

Masakane I, Tsubakihara Y, Akiba T, Watanabe Y, Iseki K (2008). Bacteriological qualities of dialysis fluid in Japan as of 31 December 2006. Ther Apher Dial, 12 (6): 457-463.

Hoenich NA, Levin R, Ronco C (2009). How do changes in water quality and dialysate composition affect clinical outcomes? Blood Purif, 27 (1): 11-15.

Vorbeck-Meister I, Sommer R, Vorbeck F, Hörl WH (1999). Quality of water used for haemodialysis: bacteriological and chemical parameters. Nephrol Dial Transplant, 14 (3): 666-675.

Gomila M, Gascó J, Busquets A, Gil J, Bernabeu R, Buades JM, Lalucat J (2005). Identification of culturable bacteria present in haemodialysis water and fluid. FEMS Microbiol Ecol, 52 (1): 101-114.

APHA, AWWA, WEF (2005). Standard Methods for the Examination of Water and Wastewater. 21st ed. American public health association, Washington DC, part 3000, 5000 and 9000 pp.:9-38.

Farhadkhani M, Nikaeen M, Akbari Adergani Ba, Hatamzadeh M, Nabavi Bf, Hassanzadeh A (2014). Assessment of Drinking Water Quality from Bottled Water Coolers. Iran J Public Health, 43 (5): 674-681.

Oie S, Kamiya A, Yoneda I, Uchiyama K, Tsuchida M, Takai K, Naito K (2003). Microbial contamination of dialysate and its prevention in haemodialysis units. J Hosp Infect, 54 (2): 115-119.

Ledebo I, Nystrand R (1999). Defining the microbiological quality of dialysis fluid. Artif Organs, 23 (1): 37-43.

Lima JRO, Marques SG, Gonçalves AG, Salgado Filho N, Nunes PC, Silva HS, Monteiro SG, Costa JML (2005). Microbiological analyses of water from hemodialysis services in São Luís, Maranhão, Brazil. Braz J Microbiol, 36 (2): 103-108.

Vaslaki L, Karatson A, Vörös P, Major L, Pethö F, Ladanyi E, Weber C, Mitteregger R, Falkenhagen D (2000). Can sterile and pyrogen‐free on‐line substitution fluid be routinely delivered? A multicentric study on the microbiological safety of on‐line haemodiafiltration. Nephrol Dial Transplant, 15 (Suppl 1): 74-78.

Bitton G (2005) Wastewater Microbiology. 3rd ed. John Wiley & Sons Inc, Canada, pp.: 419-455.

Liguori G, Cavallotti I, Arnese A, Amiranda C, Anastasi D, Angelillo IF (2010) Microbiological quality of drinking water from dispensers in Italy. BMC Microbiol, 10: 19.

Bambauer R, Schauer M, Jung W, Daum V, Vienken J (1994). Contamination of dialysis water and dialysate: a survey of 30 centers. ASAIO J, 40 (4): 1012-1016.

Morin P (2000). Identification of the bacteriological contamination of a water treatment line used for haemodialysis and its disinfection. J Hosp Infect, 45 (3): 218-224.

Gomila M, Bowien B, Falsen E, Moore ER, Lalucat J (2007). Description of Pelomonas aquatica sp. nov. and Pelomonas puraquae sp. nov., isolated from industrial and haemodialysis water. Int J Syst Evol Microbiol, 57 (Pt 11): 2629-2635.

Yoon JH, Lee MH, Oh TK (2004) Porphyrobacter donghaensis sp. nov., isolated from sea water of the East Sea in Korea. Int J Syst Evol Microbiol, 54 (Pt 6): 2231-2235.

Files
IssueVol 45 No 5 (2016) QRcode
SectionOriginal Article(s)
Keywords
Dialysis water Dialysis fluid Chemical quality Endotoxin Heterotrophic bacteria

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
SHAHRYARI A, NIKAEEN M, HATAMZADEH M, VAHID DASTJERDI M, HASSANZADEH A. Evaluation of Bacteriological and Chemical Quality of Dialysis Water and Fluid in Isfahan, Central Iran. Iran J Public Health. 2016;45(5):650-656.