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

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.

Assessment of Drinking Water Quality from Bottled Water Coolers

BACKGROUND

Drinking water quality can be deteriorated by microbial and toxic chemicals during transport, storage and handling before using by the consumer. This study was conducted to evaluate the microbial and physicochemical quality of drinking water from bottled water coolers.

METHODS

A total of 64 water samples, over a 5-month period in 2012-2013, were collected from free standing bottled water coolers and water taps in Isfahan. Water samples were analyzed for heterotrophic plate count (HPC), temperature, pH, residual chlorine, turbidity, electrical conductivity (EC) and total organic carbon (TOC). Identification of predominant bacteria was also performed by sequence analysis of 16S rDNA.

RESULTS

The mean HPC of water coolers was determined at 38864 CFU/ml which exceeded the acceptable level for drinking water in 62% of analyzed samples. The HPC from the water coolers was also found to be significantly (P < 0.05) higher than that of the tap waters. The statistical analysis showed no significant difference between the values of pH, EC, turbidity and TOC in water coolers and tap waters. According to sequence analysis eleven species of bacteria were identified.

CONCLUSION

A high HPC is indicative of microbial water quality deterioration in water coolers. The presence of some opportunistic pathogens in water coolers, furthermore, is a concern from a public health point of view. The results highlight the importance of a periodic disinfection procedure and monitoring system for water coolers in order to keep the level of microbial contamination under control.