Dialysis water treatment systems and monitoring in Italy: results of a national survey.

Background: The risks connected with dialysis fluid contamination are well established. Epidemiological stud- ies have demonstrated just how difficult it is to obtain permanently satisfactory quality standards. Therefore, dialysis centers must have effective and regular quality control programs, particularly with the growing and widespread use of on- line convective dialysis treatments. Considering this, we conducted a national survey of water treatment systems and mon- itoring in Italian dialysis centers. Methods: Two independent questionnaires were prepared and distributed in 1999 and 2001. The questions were designed to acquire information on structural and procedural elements. Responses to similar questions from both questionnaires were analyzed together. Results: Responses to questionnaires were received from 148 centers (17% of dialysis centers in Italy). In accordance with the European Best Practice Guidelines (EBPG) published recently concerning dialysis fluid purity, in the majority of centers (97%) the water treatment system consisted of at least pre-treatment and reverse osmosis (RO) modules. Howev- er, only one stage RO module was implemented (71%), there was a water storage tank (65%) and with water pipe distrib- ution loops made of sanitary polyvinyl chloride (85%). Analysis of procedural elements - the timing and type of disinfec- tion procedures used for the waterline system and monitors, the timing and type of water treatment quality control pro- cedures - revealed a striking variability among centers in terms of the types and frequency of checks performed. Conclusions: Taking into account the EBPG, this survey revealed both good and bad elements, calling for a national initia- tive aimed at defining a standard periodicity of loop disinfection, points in the water pipe line to be tested, and the fre- quency and type of tests.