title: Evaluation of Bacteriological and Chemical Quality of Dialysis Water and Fluid in Isfahan, Central Iran.
abstract: BACKGROUND
  Chemical and microbial quality of water used in hemodialysis play key roles in a number of dialysis-related complications. In order to avoid the complications and to guarantee safety and health of patients therefore, vigorous control of water quality is essential. The objective of present study was to investigate the chemical and bacteriological characteristics of water used in dialysis centers of five hospitals in Isfahan, central Iran.
  
  
  METHODS
  A total of 30 water samples from the input of dialysis purification system and dialysis water were analyzed for chemical parameters. Heterotrophic plate count and endotoxin concentration of drinking water, dialysis water and dialysis fluid of 40 machines were also monitored over a 5-month period in 2011-2012.
  
  
  RESULTS
  Concentration of the determined chemicals (copper, zinc, sulfate, fluoride, chloramines and free chlorine) did not exceed the recommended concentration by the Association for the Advancement of Medical Instrumentation (AAMI) exclude lead, nitrate, aluminum and calcium. Furthermore, the magnesium; cadmium and chromium concentration exceeded the maximum level in some centers. No contamination with heterotrophic bacteria was observed in all samples, while the AMMI standard for endotoxin level in dialysis fluid (<2 EU/ml) was achieved in 95% of samples.
  
  
  CONCLUSIONS
  Dialysis water and fluid failed to meet the all chemical and bacteriological requirements for hemodialysis. To minimize the risk of contaminants for hemodialysis patients therefore, a water quality management program including monitoring, maintenance and development of water treatment system in hemodialysis centers is extremely important. In addition, an appropriate disinfection program is needed to guarantee better control of bacterial growth and biofilm formation.
authors.affiliation: Dept. of Environmental Health Engineering, School of Health, Golestan University of Medical Sciences, Gorgan, Iran.
authors.forename: Ali
authors.initials: A
authors.lastname: Shahryari
authors.affiliation: Dept. of Environmental Health Engineering, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Mahnaz
authors.initials: M
authors.lastname: Nikaeen
authors.affiliation: Dept. of Environmental Health Engineering, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Maryam
authors.initials: M
authors.lastname: Hatamzadeh
authors.affiliation: Dept. of Environmental Health Engineering, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Marzieh
authors.initials: M
authors.lastname: Vahid Dastjerdi
authors.affiliation: Dept. of Statistics and Epidemiology, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Akbar
authors.initials: A
authors.lastname: Hassanzadeh
keywords: Chemical quality; Dialysis fluid; Dialysis water; Endotoxin; Heterotrophic bacteria