title: The evolution of technological strategies in the prevention of dialysis water pollution: sixteen years' experience.
abstract: OBJECTIVE
  This report attempts to illustrate the positive impact on the quality of dialysis water produced over a 16-year period through the progressive optimization of technological procedures.
  
  
  METHODS
  Fundamental steps included the following: elimination of polyvinyl chloride (PVC), periodical controls, introduction of stainless steel and/or polyethylene polymer and substitution of single-pass reverse osmosis (SRO) with double-pass reverse osmosis (DRO). Daily overnight automatic thermal disinfection of distribution piping rings represented the final step.
  
  
  RESULTS
  A dramatic improvement was observed in 645 water samples obtained from distribution piping. The measures applied resulted in a significant improvement of water quality, featuring levels of colony-forming units per milliliter ranging from 247.4 ± 393.7 in the presence of PVC and SRO to 14.1 ± 28.0 with stainless steel and DRO and 2.8 ± 3.2 with cross-linked polyethylene thermoplastic polymer and DRO (p < 0.01).
  
  
  CONCLUSIONS
  Dialysis water should be viewed by nephrologists as a medicinal product, and every effort should be made to ensure a high-quality liquid.
authors.affiliation: Territorial Department of Nephrology and Dialysis, ASL Cagliari, Cagliari, Italy. pg.bolasco@tin.it
authors.forename: Piergiorgio
authors.initials: P
authors.lastname: Bolasco
authors.forename: Antonio
authors.initials: A
authors.lastname: Contu
authors.forename: Patrizia
authors.initials: P
authors.lastname: Meloni
authors.forename: Dorio
authors.initials: D
authors.lastname: Vacca
authors.forename: Stefano
authors.initials: S
authors.lastname: Murtas
mesh_terms: D015312:Hemodialysis Solutions / Q000737:chemistry* / Q000592:standards*; D006757:Hospital Units; D006801:Humans; D006435:Renal Dialysis / Q000379:methods* / Q000592:standards*; D014876:Water Pollution / Q000517:prevention & control*
chemical_list: D015312:Hemodialysis Solutions