Monitorización de la calidad del agua tratada «on line» y del líquido de diálisis (LD) / No disponible

Introducción: Los tratamientos de agua «on line», están diseñados para obtener agua de gran calidad, condición indispensable, aunque no única, para conseguir LD ultrapuro. Para mantener ésta calidad es precisa la monitorización continua de la calidad del tratamiento del agua, del LD y de los monitores de diálisis. Método: Tras la instalación de un tratamiento de agua con estas características, implementamos un sistema de monitorización que incluía:a) Análisis microbiológicos, endotoxinas y químicos (analíticos y colorimétricos) en el agua en sus diferentes estadios(antes de ser tratada, en diferentes fases del tratamiento y en la red de distribución).b) Control de los parámetros mecánicos de funcionamiento del tratamiento.c) Análisis microbiológico y de endotoxinas del LD.d) Control y mantenimiento de los diferentes monitores de hemodiálisis, según las indicaciones técnicas de los mismos. Resultados: Tras cinco años de funcionamiento se ha evaluado su eficacia y la utilidad de las modificaciones introducidas a lo largo del tiempo. En este periodo no se han registrado contaminación global o parcial del agua después de ser tratada. Los incidentes registrados no han supuesto cortes de suministro o merma de la calidad que haya supuesto la paralización de la unidad de hemodiálisis, pese a los problemas derivados de las malas condiciones en que en ocasiones se encuentra el agua antes de ser tratada. Solo se registró una contaminación persistente en un monitor, que con gran certeza venía originada por el propio puerto para toma de muestras. Conclusiones: Los tratamientos de agua ¿on line¿ para hemodiálisis son los más adecuados para obtener agua de gran calidad. Han de ir acompañados de una monitorización basada en estrictos protocolos de seguimiento creados específicamente para evaluar las características del agua a tratar y tratada (AU)

Introduction: On line-treated water has been designed to obtain ultrapure water. This quality of water is obviously necessary to obtain ultrapure dialysate, although this is not the only condition. To keep the quality of the process, is necessary the continuous monitoring of the water treatment, dialysate and haemodialysis machines. Method: After the installation of a water treatment with these characteristics, we developed a protocol to follow up its quality. The measures included in the protocol were: a. - Microbiologic, endotoxin and chemical controls of the water on different stage: before and at the end of the treatment, pre-treatment and network of distribution. The chemical analysis included analytical and colorimetric measures. b. - Control of specific mechanical functions of the facilities. c. - Microbiologic and endotoxin analysis of the dialysate produced by haemodialysis machines. d. - Control and maintenance of haemodialysis machines, according to the technical indications. Results: We analyse the initial five years of water treatment with the aim to evaluate quality parameters and efficiency. We explain the reasons of the modifications introduced in the system. During this period we have not any episodes of global or partial contamination. We refer here some incidents related with the quality of raw water supply before the treatment, but in any case it was necessary neither to stop the water supply or to reduce the water quality. We observed a persistent contamination of one haemodialysis monitor due to the port used to get the samples. Conclusions: On line-treated water is at present the most appropriate system to obtain high quality water for haemodialysis. The process must be continuously monitored through specific protocols developed to evaluate the raw water's characteristics and the treated water (AU)

[Monitoring on-line treated water and dialysate quality]. / Monitorización de la calidad del agua tratada <> y del líquido de diálisis (LD).

INTRODUCTION: On line-treated water has been designed to obtain ultrapure water. This quality of water is obviously necessary to obtain ultrapure dialysate, although this is not the only condition. To keep the quality of the process, is necessary the continuous monitoring of the water treatment, dialysate and haemodialysis machines. METHOD: After the installation of a water treatment with these characteristics, we developed a protocol to follow up its quality. The measures included in the protocol were: a) Microbiologic, endotoxin and chemical controls of the water on different stage: before and at the end of the treatment, pre-treatment and network of distribution. The chemical analysis included analytical and colorimetric measures. b) Control of specific mechanical functions of the facilities. c) Microbiologic and endotoxin analysis of the dialysate produced by haemodialysis machines. d) Control and maintenance of haemodialysis machines, according to the technical indications. RESULTS: We analyse the initial five years of water treatment with the aim to evaluate quality parameters and efficiency. We explain the reasons of the modifications introduced in the system. During this period we have not any episodes of global or partial contamination. We refer here some incidents related with the quality of raw water supply before the treatment, but in any case it was necessary neither to stop the water supply or to reduce the water quality. We observed a persistent contamination of one haemodialysis monitor due to the port used to get the samples. CONCLUSIONS: On line-treated water is at present the most appropriate system to obtain high quality water for haemodialysis. The process must be continuously monitored through specific protocols developed to evaluate the raw water's characteristics and the treated water.