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.

摘要 引言：对移动透析（Mobile Dialysis, MD）服务中的水质开展监测，评估其关键风险节点并表征该流程固有风险，对于规避患者健康风险至关重要。本研究针对里约热内卢市36家开展强化治疗的医院的移动透析服务水质进行微生物学质量评估。
方法：从管网入口（NET）、反渗透后（PO）以及透析液（DS）三个采样点共采集204份水样。对水样开展异养菌计数、致病菌筛查、内毒素检测及铝含量测定。
结果：36家医院的3类采样点中，整体细菌污染率为30%（32/108）；其中透析液组污染率达42%，反渗透后组为31%，管网入口组为17%，三类采样点均检出铜绿假单胞菌（Pseudomonas aeruginosa）、嗜麦芽窄食单胞菌（Stenotrophomonas maltophilia）、洋葱伯克霍尔德菌（Burkholderia cepacia）及皮氏罗尔斯顿菌（Ralstonia pickettii）。反渗透后组有77%（17/22）的检测样品内毒素浓度超过0.25 EU/mL。铝含量方面，47%（7/15）的反渗透后样品及27%（4/15）的管网入口样品铝含量超出0.01 mg/L限值。目前尚无针对移动透析用水的专项法规，因此采用国家卫生监督局（National Health Surveillance Agency, Anvisa）RDC 11/2014号决议中针对常规血液透析服务的限值标准。
结论：本研究结果凸显了对移动透析服务开展水质评估的重要性，可为保障患者安全提供支撑，并为该流程作为医疗健康促进环节的卫生监测工作提供依据。