Case Study
Microbiological control is essential for ultra
how a dialysis center was able to reduce the amount of hours disinfecting, and improve patient care by
reducing the risk of complications from bacteria and endotoxin.
Bacteria and its endotoxin byproducts are a universal
concerted effort t
microbiological standards that will require much better filtration of contaminants than most dialysis
centers currently have in place.
This case study focuses on a center that had microbiological issues with
systems. Although m
standards, they are often
Because of this, acute dialysis patients are more often at risk to water
A nursing care center for seniors
the RO systems usage was sporadic, they sometimes sat idle for periods of time. Microbiological tests
on the RO water (LAL and endotoxin levels) consistently had levels exceeding the
dialysis wa
events that lead up to the Nephros filter being installed on the RO.
October 2009
Water samples were taken from the portable RO. The CFU
count was >200, and the LAL endotoxin level was 5.24…both
well above the AAMI standards. The center changed their
disinfection schedule from monthly, to every other week.
November 2009
Water samples from the portable RO
standards. The CFU count was
level had improved, it was still above the AAMI action level.
The director of the center was getting desperate for answers
as long as the result
week, hoping this would help solve the problem.
December 2009
The December 2009 results showed a great improvement for the CFU count, which was now
AAMI’s action level) but th
to maintain them at low levels. The AAMI committee recently approved new lower
ers most portable water treatment
water. This required them to constantly disinfect their system.
he results were above the AAMI action levels.
o ost idle for long periods
. still >200
s the endotoxin level was still above the action level at 1.95.
Nephros Filter
ultra-pure water, especially endotoxin control.
of time,
portable reverse osmosis
were taken and again showed a level that exceed
with an
e – Superior Microbiological Filtration
problem in all dialysis water systems and require a
systems are designed to meet high water quality
increasing the chance for the buildup of bacteria.
endotoxin level
water-borne contaminants.
systems for their dialysis needs. Since
The following is the sequence of
of 1.95. Even though the endotoxin
and a solution. The RO could not be used
decided to have the RO
Test Dates
October 4
November 3
December 3
*Exceeds AAMI standards for dialysis water.
This is the story of
portable reverse osmosis
AAMI standards for
ober 4, 2009
3, 2009
3, 2009
exceeded AAMI
disinfected every
1 (below
>200* 5.24*
>200* 1.95*
1 1.95*
1303 Stanley Ave • Dayton, OH 45404 • Phone (937) 461-8833 • Fax (937) 461-1988
The director was at a complete loss on what to do next, so she contacted AmeriWater for advice.
AmeriWater provided her with a Nephros dual stage microbiological filter. The Nephros filter has nearly
four times the filtering capacity of comparable filters and filters all the way down to 0.005 microns. It is
the only dual stage filter on the market and provides up to 12 months of performance life with frequent
The center installed the new Nephros filter
on the portable RO and was amazed with the
results. The CFU count was zero, and the
endotoxin levels were <0.5.
Because of these results, the center decreased the amount of disinfections (saving them time and
money), and now has the comfort of knowing they are providing water of the highest quality during
their dialysis treatments. They also love the fact that the Nephros filter can withstand multiple
disinfections…even when disinfected with ozone.
Since installing the filter, the monthly water test results have continued to be well below AAMI
standards for dialysis water.
LAL/Endotoxin Test Results
Test Dates CFU LAL
October 4, 2009 >200* 5.24*
November 3, 2009 >200* 1.95*
December 3, 2009 1 1.95*
January 4, 2010 0 <0.5
February 9, 2010 0 <0.5
March 2, 2010 0 <0.5
April 4, 2010 0 <0.5
* Results greater than AAMI standards for dialysis water.
Colony Forming Units Action Level ≥ 50
Endotoxin Units Action Level ≥ 1
With the low-level test results, the director finally felt at ease knowing that her patients’ risk of
complications from bacteria and endotoxin had been greatly reduced. The center has continued to
purchase portable reverse osmosis systems from AmeriWater with the Nephros filters factory installed.
In addition, they are also having the filters installed at each central system wall box as a final safeguard
for point of use patient safety.
For more information on water treatment products and accessories for dialysis contact AmeriWater Inc.
December 15, 2009 – Nephros
filter installed on RO. The
result… perfect test results!
INLET Stage 1 Stage 2 OUTLET