Monitoring the bacterial count and maintaining the water quality for haemodialysis as per recommended guidelines requires constant vigilance by the dialysis staff. This is particularly problematic with chemically sterilised portable Reverse Osmosis units when they are used intermittently for Intensive Care treatments. In early 2007 high bacterial counts caused a number of interruptions to the acute haemodialysis service lasting two - six weeks, as staff attempted to decontaminate the unit. This occurred over a twelve-month period.

A literature review was undertaken and liaison with a number of related departments and companies occurred as answers were sought. Systematic assessment and evaluation of all procedures relating to the disinfection of the water treatment plant and the collection of samples was carried out. A review of laboratory testing techniques and reports was also implemented by microbiology.

Via a process of elimination two major sources of contamination were identified - Intensive Care tap water and staff contamination during specimen collection. Renal unit policy was changed to include flushing of Intensive Care taps for five minutes prior to connection to the portable Reverse Osmosis unit. Renal staff are now educated and assessed for annual competency on the collection of water specimens.

Follow up review of water results in September 2008 showed a vast improvement in the bacterial counts with the majority well within standards. However we are still finding the occasional inconsistent reading. A trial of an additional inline filter has commenced. The results of this trial will also be included in the presentation.