Monitoring the quality of the water used in mobile dialysis services in intensive care units in the city of Rio de Janeiro

Abstract

Introduction: Monitoring water quality in mobile dialysis (MD) services, assessing critical points and characterizing the risks inherent in the process, is essential to avoid risks to the patient's health. This study evaluated the microbiological quality of water in the MD of 36 hospitals with intensive treatment in the city of Rio de Janeiro. Methods: 204 water samples were collected from the points of entry to the network (NET), post-osmosis (PO) and dialysis solution (DS). The samples were evaluated for heterotrophic bacteria count, pathogen search, presence of endotoxins and aluminum content. Results: Bacterial contamination at 3 collection points in 36 hospitals was 30% (32/108); 42% from DS, 31% from PO and 17% from NET, with the presence of Pseudomonas aeruginosa, Stenotrophomonas maltophilia , Burkholderia cepacia and Ralstonia pickettii in the 3 points. Endotoxin concentrations above 0.25 EU/mL occurred in 77% of the samples (17/22) analyzed in the PO. In the aluminum content, values above 0.01 mg/L were presented in 47% (7/15) of PO samples and 27% (4/15) of NET samples. There is no specific legislation for water used in the MD; therefore, the limits of the RDC of the National Health Surveillance Agency (Anvisa) 11/2014 were used; which regulates conventional hemodialysis services. Conclusion: The results highlight the importance of evaluating water quality in MD services to ensure patient safety and support the sanitary monitoring of this process as a healthcare promoter.

Quality of dialysis water and dialysate in haemodialysis centres: Highlight for occurrence of non-fermenting gram-negative bacilli

“…However, it must be highlighted that, due to technical limitations, these samples were not investigated for occurrence of metals (e.g. aluminium, lead, zinc and copper), which have been mentioned by some authors (Braimoh et al 2012; Abualhasan et al 2018; Jesus et al 2021).…”

“…In Brazil, P. aeruginosa and B. cepacia were observed in dialysis water and dialysate samples collected from different points in the haemodialysis system of a hospital in Campinas, São Paulo, after an outbreak of bacteraemia (Pisani et al 2000), and Lima et al (2005) identified NFGNB in 38.9% of post‐treatment water samples used in haemodialysis services in São Luís, Maranhão. NFGNB were also the main micro‐organisms associated with haemodialysis fluids in studies carried out in Franca, São Paulo (Montanari et al 2009), and in the city of Rio de Janeiro (Jesus et al 2021).…”

Water quality and adverse health effects on the hemodialysis patients: An overview

“…One of the first effects related to water quality was the so-called "hard water syndrome," characterized by nausea, vomiting, lethargy, severe muscle weakness, and high blood pressure during dialysis sessions. This condition has been directly linked to large amounts of calcium and magnesium in untreated water [42].…”

“…The toxic effects noted are Progressive Dementia Syndrome and neurological deterioration, which can lead to death due to the high concentration of aluminum in the brain. It can also cause bone disease by replacing the calcium in the bones with aluminum, leading to osteoporosis [42].…”

Evaluation of Some Chemical Parameters of Hemodialysis Water: A Case Study in Iran

“… 10 - 12 In another study conducted by Suzuki et al 13 on the quality of dialysis water in Brazil, it was found that the concentration of copper, nitrate and aluminum in dialysis water is higher than the standard limits. The studies of Abualhasan et al 7 in Palestine, Vorbeck-Meister et al 14 in Vienna, Austria, Hilinski et al 15 in Brazil, Ocunola and Olaitan 16 in Nigeria and Jesus et al 17 in Riode Jeneiro, Brezil also showed that the quality of water used for hemodialysis patients was not up to standard.…”