Kontroll av dialysevann til hemodialyse, Seksjon for dekontaminering, Oslo Universitetssykehus, 2013-2023

Abstract

Background: The laboratory at the Decontamination Unit, Oslo University Hospital, has analyzed water used for dialysis treatment from dialysis units across Norway during the period 2013-2023. The sample materials include dialysis water, dialysis fluid, and substitution fluid. The details and results have not been previously reviewed. Aim: To review the data collected and analyze the results with the aim of: 1) Establishing an overview of the material, 2) Examining changes over time, 3) Identifying variables associated with positive test results, 4) Formulating recommendations and suggestions for quality improvement in monitoring and control. Materials and Methods: Data collected by the laboratory 2013-2023, based on information provided by requesters and analysis results. The laboratory tests the samples for viable microbes and endotoxins. Results: The total number of water samples received by the laboratory has steadily declined over the years, while the number of samples from dialysis water has remained stable. The proportion of positive samples increased significantly from 2020-2023, primarily testing positive for endotoxins. Dialysis performed outside hospitals or outside the hospital's central water purification systems accounts for most of the positive dialysis water samples. Both dialysis outside hospitals and the number of positive samples are increasing. There is no clear correlation between positive test results and different seasons. Conclusion: Lack of procedures guiding how the laboratory's collected data is analyzed, interpreted, and distributed makes it difficult to ensure the quality of dialysis water on a national basis. Therefore, we cannot conclude that there are more positive samples from dialysis satellites and mobile water purification units than from central water purification systems in hospitals. Implications: With a better data management system, there is significant potential for improved monitoring of dialysis water quality for individual hospitals/requesters and in general. This could contribute to better quality dialysis treatment for chronically ill kidney patients.