Water quality results HHD

[mike.jones]

Hi folks,

We are having some failures on water quality at home. We currently use gambro WRO hots and patients are advised to perform a ‘heat’ twice a week. Even when we have this set for automatic start we are finding water quality is above guidelines in some cases. We have tried chemical disinfectant with varying results. We now use chemical disinfectant 3 times a year.

Is there anything else I can do or is it time to bite the bullet and start replacing RO’s?

Maybe UV system. There are some for approx £100 that would be suitable.

[Ian Wilde]

Hi Mike,

Where are you taking the sample from?
It could be your tubing, bottles, sample ports, technique, sterilization method for sample ports - there's a lot of variables.
If you stick a UV in your system be sure to have something further down stream to catch whatever it kills.

What other info do you have about your home setup?

Ian

[mike.jones]

Hi Ian,

Thanks for the response.
We sample from the RO, the tubing is the Gambro loop so no dead legs.
I think/hope we all sample with good technique but you never know.
We sterilise the sample point and the connector in 70% alcohol.

If I were to go down this route I would look at UV prior to RO with some further filtration in-inbetween.

What other info regarding our home setup were you thinking of.

KR

Mike

[KevinJGibbs]

Mike,

Do you have a sample port on your loop from the WRO?

We have fitted them to all our Gambro WRO' in the home and portable WRO's in the trust and we haven't had a failure for sometime now!

Regards

Kevin

[mike.jones]

Hi Kevin,

No we don’t have a sample port as such. We take the sample from the female connector by plugging in a male stub.
I will test your method tomorrow and see the difference in results.

Thanks for the idea.

P.s
What type of sample port do you use?

[KevinJGibbs]

Hi Mike,

We use the sample ports that are used on the Dialog+ machines and we've had these on for about 5 years without issue.

We change them every year during an annual service.

Regards

Kevin

[Chris Bates]

If fitting new sample ports doesn't work, do you think there might be large amounts of contamination in the pre-treatment ?
Anything after the carbon has no chlorine to reduce growth.
Over the years I have found a lot of colourless translucent jelly in RO inlet valves and tubes. Even had a couple of valves stop working due to gel blocking the bleed hole in the membrane.
Maybe replacing the hose and filter housings and replacing inlet valves would help??

[Garry]

Slightly late to this thread but I assume you are referring to poor quality as in microbiology.  Have you ever replaced the membranes?  We have 10 wro300H units and all started giving inconsistent microbiology after around 5 years.  Water quality/conductivity all seemed good.  Eventually we replaced membranes and this resulted in an immediate improvement. Five years later and still giving good results.  We heat disinfect once per week, citric once per year.  Ours are used daily so that may contribute to the good results we get.

Sampling wise we just use a male rectus 21 type connector and sample after running a few litres off.

[mike.jones]

Hi Guys,

Bit of an update:

Since insisting patients heat clean, setting up auto flushes and a dash of dialox later we are getting much better results.
We also changed the product loop.

On 10-20% that have still been poor we have replaced the membrane and so far so good.

I would also add that this is alongside changing Labs.

The WRO training course was very good and informative.

KR

Mike

[colemanri]

Hi Guys

would be interested on which lab you use? I was using 20/30 labs but wasn't happy with customer care ie not answer e-mails testing the water to the wrong standard so I went over to ALS. What a mistake that was, the last 4 times I sent samples the results were outside parameters when I complained they said the samples were registered late. I raised a complaint and the answer was due to staff sickness/flu. when I asked if this not happen in the future they didn't respond so I went back to 20/30 labs which so far have been very good.

I am interested on how often you sample been having a ding dong with our infection control about testing the renal machines. we sample the rings 1 x week for chlorine, 1 x month for tvc  and endotoxin 1 x quarter full chemical and the renal machines 1 x year for tvc and endotoxin.

richard

[mike.jones]

Hi Richard,

I was using ALS, then after they lost their accreditation we switched to 20/30.
We have had a couple a issues with 20/30 (similar to what you mentioned) and now are looking at other labs, Alpha scientific, Latis and maybe ALS now that they are accredited again.

Hope that helps.

Mike

[colemanri]

Hi Mike

 

I wouldn’t go near ALS, on 4 separate occasions they registered my samples a day late even though I paid for a before 10:00am delivery. This put me back over a month on testing, when I complained they stated the reason was down to sickness and being short staffed but this happened over a 2 month period. I e-mailed them asking that” could they make sure this didn’t happen again” I had no reply hence going back to 20/30. For the money they were charging the service was awful.

 

I am interest in other departments water testing frequency what do you do at your place??

 

Regards

 

Richard

 

 

Richard Coleman

Medical Engineering Manager

Medical Engineering Department

James Paget University Hospitals NHS Trust

Lowestoft Road

Great Yarmouth

Norfolk

NR 31 6 LA

Tel: [phone]

Fax: [phone]

Main Contact: 01493 452452  bleep 1084

 

From: mike.jones [via ART Forum] [mailto:ml+[hidden email]]
Sent: 15 March 2018 21:25
To: Coleman Richard
Subject: Re: Water quality results HHD

 

Hi Richard,

I was using ALS, then after they lost their accreditation we switched to 20/30.
We have had a couple a issues with 20/30 (similar to what you mentioned) and now are looking at other labs, Alpha scientific, Latis and maybe ALS now that they are accredited again.

Hope that helps.

Mike

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[Garry]

Richard we do the same as you in centre apart from full chemical, that we have extended after previous trend analysis.  Aluminium remains at quarterly.

We use ALS for TVC and full chemical analysis.  All has been good so far. This maybe helped by the fact they are local and we drop off our samples directly.

[colemanri]

Cheers Gary

 

Regards

 

Richard

 

 

Richard Coleman

Medical Engineering Manager

Medical Engineering Department

James Paget University Hospitals NHS Trust

Lowestoft Road

Great Yarmouth

Norfolk

NR 31 6 LA

Tel: [phone]

Fax: [phone]

Main Contact: 01493 452452  bleep 1084

 

From: Garry [via ART Forum] [mailto:ml+[hidden email]]
Sent: 16 March 2018 08:34
To: Coleman Richard
Subject: Re: Water quality results HHD

 

Richard we do the same as you in centre apart from full chemical, that we have extended after previous trend analysis.  Aluminium remains at quarterly.

We use ALS for TVC and full chemical analysis.  All has been good so far. This maybe helped by the fact they are local and we drop off our samples directly.

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[Ian Wilde]

Hi Mike,

We are dipsticking chlorine on a weekly basis just as a simple pass/fail indicator.  Monthly we get the Chlorosense out take an accurate reading.  We do TVC and Endo on a monthly basis, the Mandatory suite from ALS on a quarterly basis.  

Had lots of problems with ALS to begin with but after much discussion and using their bottles things seem to have now calmed down.

[mike.jones]

Hi Folks,

thought i'd check in with another update.

So far we are 80-90% below ISO/RA standards, with a few fails require action/membrane or scrapping.
Have bit the bullet and started replacing RO.
We have gone with the Aqua UNO. Very good RO FYI and if you buy enough the price is not too bad(for Fres)


Two things I was hoping for.

Any big HHD programs out there with great water results that wouldn't mind a visit from us to see what best practice we are missing?

Any HHD programmes out there that are not getting great results and what you are doing about it?


KR

Mike

[Ian Wilde]

Hi Mike,

Was just looking through this old thread and noticed you never had a response to your final questions.

We have 58 at home on the 5008S machine using an Aqua Uno (cold disinfection variant).  While I'm sure we're not perfect I'm happy to share what we do and the results we get.  Perhaps if you then could get the same info from someone who uses the same equipment as you for comparison it may help.  If you've got everything sorted anyway since your original post then its happy days!

[mike.jones]

Hi Ian,

Thanks for the reply.

You sound of similar size to us.

We are still improving but finding some of the historic home installs are not ideal and modification is needed.

If you have some time for me to bend your ear it would greatly appreciate it.

Thanks again,

Mike

[Ian Wilde]

No problem, you've got my email so you know you can contact me whenever.  If you can make it to the conference in October we can discuss it over a pint