Table 4.
Monitoring tasks for a clinic water treatment system
| Component | Monitor | What to Look For | How Often |
|---|---|---|---|
| Pretreatment | |||
| Blending valve | Water temperature | Appropriate temperature (65–85°F) | Start of each day of operation |
| Booster pump | Water pressure | Pump turns on and off at appropriate times or flow rates | Periodically |
| Depth/multimedia filter | Pressure drop across device; backflush timer | Δ≤15 psi; set to backflush after facility operation hours | Start of each day of operation |
| Water softener | Pressure drop across device | Δ≤15 psi; timer always visible | Start of each day of operation |
| Water softener | Media regeneration time | Set to regenerate media with brine wash after facility operation hours | |
| Brine tank | Salt level in tank | Adequate amount of salt pellets; no salt bridge in the tank | Start of each day of operation |
| Carbon tanks | Pressure drop across device; backflush timer | Δ≤15 psi per tank; set to backflush after facility operation hours | Start of each day of operation |
| Carbon tanks | Chlorine and chloramine levels in the water between primary and secondary tanks | Total chlorine ≤0.1 PPM | Before the first patient treatment of the day and every 4 h after the first patient until the end of day |
| Reverse osmosis prefilter | Pressure drop across device | Δ≤20 psi | Start of each day of operation |
| Purification | |||
| Reverse osmosis device | Percentage rejection level | ≥90% | Start of each day of operation |
| Reverse osmosis device | Product water purity | Device sensors for conductivity and TDS are set according to the manufacturer’s recommendations | |
| Distribution | |||
| Distribution loop | Flow of water at end of the loop | >3 ft/s (indirect) | Periodically |
| >1.5 ft/s (direct) | |||
| Bacterial cultures and LAL testing | |||
| Reverse osmosis device, holding tank, and distribution loop | Water cultures | <50 CFU/ml | No less than one time per month |
| Reverse osmosis device, holding tank, and distribution loop | LAL testing for endotoxin | <1 EU/ml | |
| Chemical testing | |||
| Source water entering the water treatment system; product water from the reverse osmosis product line | AAMI inorganic chemical analysis; contamination analysis | Chemical compounds below the AAMI safety thresholds for purified dialysis watera | Annually and when a new water system is installed, the reverse osmosis membrane is replaced, rejection is <90%, or there are seasonal changes in source water |
PPM, parts per million; TDS, total dissolved solids; LAL, limulus amebocyte lysate; EU, endotoxin unit; AAMI, Association for the Advancement of Medical Instrumentation.