Abstract
The necessity of purification of dialysis fluids has been discussed since the 1980s. The Japanese Society for Dialysis Therapy (JSDT) presented a standard for dialysis fluid purification in 1995 and revised three times after that. Lastly, JSDT presented a new standard on microbiological management of fluids for Hemodialysis and related therapies in 2008 (the 2008 JSDT standard). It, however, specifies biological contaminants (ET and bacteria) alone.The society further revised the 2008 JSDT standard with the addition of the water quality standard for chemical contaminants and management standard for water treatment equipment in 2016 (the 2016 JSDT standard). This article describes the 2016 JSDT.Chapter 1 describes the water quality standard for biological contaminants without any modification of the standard values in the 2008 JSDT standard because the ultrapure dialysis fluid standard was met at 66.4% of all responder facilities in a 2014 survey conducted by the JSDT.Chapter 2 describes the water quality standard for chemical contaminants. Twelve items are specified in the standard, inasmuch as the toxic potentials of these chemicals have been verified, or are suspected. When the water treatment equipment is operated appropriately, chemical contaminants are appropriately removed from raw water and safe dialysis water is supplied to dialysis machines. However, chemical contaminants in raw water should be confirmed at least before installation of the water treatment equipment. In the daily management, water quality data on the source of raw water must be confirmed in each season of the year. If some chemical contaminants in source of raw water do not meet the water quality standard, the relevant chemical contaminants in dialysis water should be measured at least once a year.Chapter 3 describes the measurement of the residual chlorine. The concentration of total residual chlorine (total chlorine) in dialysis water should be less than 0.1 mg/L.The management standard for water treatment equipment is proposed in Chapter 4. Chapter 5 describes in detail the management.
Highlights
Background and objectivesThe necessity of purification of dialysis fluids has been discussed since the 1980s, primarily in Europe
Thereby, it is expected that purification in whole process from dialysis water to final dialysis fluid can be achieved
Commentary When the water treatment equipment is operated appropriately, chemical contaminants are appropriately removed from raw water and safe dialysis water is supplied to dialysis machines
Summary
3. Management of the total residual chlorine should be carried out with reference to Additional file 1: Table S1: “Management standard of water and device/unit”. 4. The concentration of total residual chlorine in raw water could increase at times of disasters or in case of emergencies; strengthening management of activated carbon after these incidents is of importance. Since there are a variety of devices available from many manufacturers, management of the water treatment equipment is left to each dialysis facilities. The Dialysis Equipment Safety Management Committee at each dialysis facility must conduct daily management with reference to the “Management Standard for Water Treatment Equipment.”. Chapter 5: supplement and management standard for water treatment equipment In Japan, water treatment equipment is not classified under the category of medical devices, and each manufacturer establishes their original standards and conduct production control and quality control. In light of the current situation, the Japanese Society for Dialysis Therapy has set up a management standard for water treatment equipment to ensure preparation of safe and stable dialysis water
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