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Introdução: A doença renal crônica caracteriza-se pela perda da função dos rins levando a um desequilíbrio funcional, fisiológico e biológico. Um dos tratamentos necessários ao paciente renal crônico é a hemodiálise onde a qualidade da água é de fundamental importância para reduzir riscos aos pacientes. Através da Resolução RDC nº 11, de 13 março de 2014, a Agência Nacional de Vigilância Sanitária (Anvisa) estabeleceu a pesquisa de endotoxinas, cuja contaminação por via venosa poderá causar vários agravos à saúde dos pacientes. Objetivo: Identificar endotoxinas em água purificada para hemodiálise. Método: Trata-se de um estudo transversal descritivo quantitativo para verificação da presença de endotoxinas em 126 amostras de água, coletadas em dois pontos (pós-osmose reversa e sala de reúso) nas seis clínicas de terapia renal substitutiva, pela Vigilância Sanitária Estadual, analisadas no LACEN, em Campo Grande, Mato Grosso do Sul, 2016. Resultados: Das 68 amostras de água coletadas após o processo de osmose reversa, três (4,41%) e das 58 amostras coletadas na sala de reúso, seis (10,34%) apresentaram resultados de endotoxinas acima do valor permitido pela legislação (0,25 EU\mL). Conclusões: Os resultados encontrados indicam comprometimento da membrana do processo de osmose reversa e, ou presença de biofilme nas tubulações, ineficácia do processo de limpeza do reservatório, tubulações, e desinfecção das máquinas.
Introduction: Chronic kidney disease is characterized by loss of kidney function leading to a physiological and biological functional imbalance. One of the treatments necessary for the chronic renal patient is hemodialysis. Water quality is critical to reducing patient risk. Resolution RDC n. 11, of March 13th, 2014, from Brazilian Health Regulatory Agency (Anvisa) establishesd the search for endotoxins, as venous contamination by endotoxins may cause various problems in the patients' health. Objective: To identify endotoxins in purified water for hemodialysis. Method: This is a Quantitative Descriptive Cross-sectional Study to verify the presence of endotoxins in 126 water samples collected at two points (post-reverse osmosis and reuse room) at six renal substitution therapy clinics, by the State Sanitary Surveillance, and analyzed in the LACEN, in Campo Grande, MS, in 2016. Results: Of the 68 water samples collected after the reverse osmosis process, three (4.41%), and of the 58 samples collected in the reuse room, six (10.52%) presented endotoxin results above the amount allowed by the legislation (0.25 EU\mL). Conclusions: Results indicate membrane involvement of the reverse osmosis process, and, or presence of biofilm in the pipes, and inefficiency of the cleaning process of the reservoir, pipes, and machines disinfection process.
ABSTRACT
Objective: To design a disinfection system for pipeline of dialysis water that can be automatically controlled so as to improve the disinfection effect, and ensure the health and safety of the operators and patients with hemodialysis. Methods: In the new disinfection system, the manual control was changed to single chip, and the disinfection method was ozone disinfection. In the actual ozone disinfection instrument for the pipeline of dialysis water, through the relationship among solubility, half-life period and temperature of underwater ozone to obtain a simulate relational expression between disinfection time and temperature, and then through single chip to achieve automatic control of disinfection process. Results: Through experimental verification, the system was able to coordinately complete automatic disinfection, emptying and swashing, and the concentration of ozone could meet the requirements of setting. Conclusion: The design can effectively disinfect the pipeline of dialysis water and avoid harm for human body in operation. And the added functions, automatic emptying and swashing, can ensure the pipeline of dialysis water is applied in dialysis cure as soon as possible after the disinfection was completed, and it guarantee the safety of hemodialysis.
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Objective To investigate current status of hemodialysis,and qualified status of dialysis water and dia-lysate in a city. Methods Status of hemodialysis in 36 medical institutions in a city which conducted blood purifica-tion programme was surveyed,dialysis water and dialysate were collected to perform microbial detection(including conventional and low temperature culture methods)and on-site ATP detection.Results 13.89% of equipments for water treatment were used less than 1 year,5.56% were used for more than 10 years. 77.78% of medical institu-tions didn't replace sand filtration which had been used for more than 1 year,the replacement time of 72.22% of fil-ter core was less than 3 months,2.78% of reverse water supply pipeline was used for more than 10 years.77.78%of medical institutions used finished A solution,72.22% used finished B solution,22.22% used centrally provided A solution,19.44% used centrally provided B solution,and 8.34% used self-made B solution. Routine microbial detection in 36 medical institutions were qualified,but 80.56% of detection results were"0" value for long period;ATP detection of on-site collected dialysis water and dialysate were all qualified. One specimen for microbial detec-tion under normal temperature exceeded the standard,2 reached the intervention value;4 specimens for microbial detection under low temperature exceeded the standard,6 reached the intervention value;qualified rates of 3 kinds of detection methods among different levels of medical institutions weren't significantly different(all P>0.05).Con-clusion The overall quality of hemodialysis water and dialysate in this city is good,the majority of medical institutions pay attention to the routine maintenance of water treatment equipment,detect the quality of hemodialysis water and dialysate regularly,but microbial detection technique needs to be improved,causes for abnormal results or intervention value of rou-tine detection needs to be analyzed and improved continuously.
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Objective To evaluate detection effect of three methods on monitoring microbes in dialysate and dialysis water for hemodialysis.Methods Seventy-two dialysate and dialysis water specimens were collected from 36 medical institutions,specimens were cultured with three methods: blood agar plate incubated at 35℃ for 72 hours,Tryptic soy agar(TSA)plate incubated at 35℃ for 72 hours,and Reasoner's 2A agar(R2A agar)plate incubated at 23℃ for 168 hours,colony counts,isolation of colony,and detection rate of colony exceeding action level(≥50 CFU/mL)were compared among three methods.Results The colony isolation rates of microbes in dialysate and dialysis water detected by blood agar plate,TSA plate and R2A plate were 40.28%,63.89%,and 69.44%respectively,difference was significant(x2=14.16,P<0.05);pairwise comparison showed that isolation rates of colony on R2A agar plate and TSA plate were higher than blood agar plate.There was significant difference in isolated colony count between blood agar plate and R2A agar plate,TSA plate and R2A agar plate respectively(Z=-4.515,-6.970 respectively,both P<0.05).The rates of isolated colony exceeding action level in dialysate and dialysis water detected by blood agar plate,TSA plate,and R2A agar plate were 1.39%,4.17%,and 20.83%respectively,difference was significant(x2=19.83,P<0.05),detection rate of R2A agar plate was higher than the other two methods.Conclusion The detection rate of colony by R2A agar plate and TSA plate are better than blood agar plate,detection rate of colony exceeding action level by R2A agar plate is higher than TSA plate and blood agar plate,R2A agar plate for microbial monitoring(23℃,168 h)on dialysate and dialysis water is superior to the other two methods.
ABSTRACT
Considerando a importância da qualidade da água tratada nos serviços de diálise para prevenção de riscos aos pacientes renais crônicos, foi estabelecido o programa de monitoramento com a finalidade de avaliar a qualidade da água tratada nos serviços de diálise do Estado de São Paulo, com base nos parâmetros estabelecidos pela Resolução RDC nº 154/2004. Foi atestada a efetividade das ações de vigilância sanitária que tem resultado em aumento dos níveis de qualidade da água tratada em vários dos parâmetros analisados, o que indica a importância da continuidade dos programas de monitoramento com intuito de garantir a segurança dos pacientes.
Considering the relevance of the quality of treated water in dialysis units to prevent the risks for patientswith chronic kidney diseases, a Monitoring Program has been established in order to evaluate the quality of treated water used in the dialysis units of the state of São Paulo, based on the parameters establishedby Resolution RDC # 154/2004. The effectiveness of the sanitary surveillance activities was evidencedbecause the consistent water quality has been improved on several analyzed parameters, which indicatesthe importance of keeping up the treated water-monitoring program at hemodialysis units in order toguarantee the patients safety.