Biologically Safe Water Filters

Hospital acquired infections killed 48,000 patients and cost $8.1 billion in 2006.  A study released by Resources for the Future focused on hospital-acquired pneumonia and sepsis. The study estimated that 1.7 million healthcare-associated infections (HAI) are diagnosed every year.According to the study a lapse in infection control can lead to extra days in the hospital and in some cases death.

Hospital water systems are often overlooked and can be the source for many of these infections. High risk areas such as ICU, transplant, oncology, hematology, burn unit, dialysis, etc. can benefit from the new Nephros Dual Stage Ultrafilter (DSU). The DSU filters to .005 microns which exceeds the CDC recommendations of .02 micron bacterial filtration. The DSU is a cost effective method of providing biologically pure water at the point of use.

Severe burn victims need their wounds scrubbed to prevent infection and to speed up the healing process.  There is growing support for washing burns with mild soap and tap water.  Once a burn wound has been cleaned, it should be thoroughly rinsed.

Studies show that, in practice, most burn units shower their patients with tap water.  the goal of cleansing is to remove dirt and debris, facilitate debridement of eschar and minimize the bioburden in the wound

When showering or using a whirlpool for physical therapy, the risks of infection from hospital water sources can be significantly reduced by filtering the water just prior to patient use.  The Nephros DSU is available for showers, sinks, whirlpools, ice machines, etc.  This filter is a .005 micron filter.  Most other filters only filter down to .02 microns.

The DSU should last about 3 months (vs 1-2 weeks) depending on use.  The filter is easily changed out using quick disconnect couplings.  The Nephros DSU provides a cost-effective method for eliminating waterborne pathogens and providing biologically pure water.  See specifications here.

The Nephros dual-stage ultrafilter (DSU) is a .005 micron ultrafilter for endotoxin control.  The filter will last about one year under normal conditions, post RO/DI, in a dialysis setting.  The DSU can be disinfected in place.  It can be part of a portable RO/DI or a final filter just before the dialysis machine (i.e. at wall box) or part of the RO water or bicarbonate loop.

Dialysis machine manufacturers include a .02 micron filter as part of their equipment.  Some of these filters degrade rapidly when exposed to disinfectants such as bleach and ultrafiltration is lost.

Most machine filters have to be changed every 2-3 months.  The yearly cost of multiple filters, plus the time to change them out along with the potential for failing the .02 micron filtration, adds up to more than the cost of using the Nephros DSU.

Ultrapure water/dialysate has multiple benefits for the dialysis patient, and used effectively, it can also lower overall costs for the dialysis facility.

Many acute dialysis units struggle to keep their portable RO/DI water supply for dialysis machines from exceeding the AAMI endotoxin standards.

Special considerations for acute hemodialysis have been issued.  You can find these standards at the following link ANSI/AAMI RD52:2004 Dialysate for hemodialyzers . The following are found under amendment 3 - Annex E.

E.2 Fluid Quality: suggests achieving higher fluid quality by passing final dialysate through a bacteria-and endotoxin-retentive filter.

E.3.7 Endotoxin-retentive filters: recommends in-line dialysate filters as a final barrier against contamination of the dialysate.

E.4 Microbial control strategies: “Consideration should be given to installing an in-line dialysate filter in the dialysis machine, if the machine manufacturer allows that option.”

The Nephros DSU contains a .005 micron membrane which eliminates bacteria, viral agents, cysts, fungi and biological endotoxins.  The DSU will produce ultrapure water when used post RO/DI.

One “Superbug” can cost a hospital $60,000.  Researchers at Duke University found that patients required more than 3 weeks of additional hospitalization after acquiring an infection while in the hospital.

The study suggests hospital administrators and infection control personnel should use these costs to design and evaluate specific preventative interventions.

The Nephros DSU (Dual Stage Ultrafilter) is designed to filter water used in ICU’s, burn units, etc.  This .005 micron filter will eliminatea variety of bacteria, parasites and fungi.

AAMI is considering adopting a number of ISO standards.  The main impact on dialysis water quality would be to lower the bacteria limit to 100 CFU/mL instead of 200 CFU/mL (action is still at 50).  Acute units would be the first to be impacted by tighter standards.

At 50 CFU/mL and a dialysate flow of 800mL/min. an average treatment will expose the dialyzer to 9.6 million colonies of bacteria.  At 5 CFU/mL, it drops to 960,000 colonies/treatment.  The patient will not be impacted by all the bacteria but will be exposed to some.

Bacteria can affect the patient in multiple ways.  Since the dialysis provider cannot tell when the bacteria level is high, it’s easier and safer to install an ultrafilter to protect the patient.  Ultrafilters can also be installed on portable RO units to reduce endotoxin levels in acute units.

Many ultrafilters last 3 months or less.  The DSU from Nephros has a 510k for dialysis approval and lasts 6 months.  This filter utilizes quick connects and can be easily changed.

A new initiative was announced by HHS Secretary Kathleen Sebelius, to fight costly and dangerous health care-associated infections (HAI’s).

According to the Oct. 23/PRNewswire-USNewswire article, nearly 2 million patients develop HAI’s, which contribute to 99,000 deaths each year and $28-$33 billion in health care costs.

Hospital water systems are a source of many infections.  Water purification will reduce or eliminate these waterborne infections.  Nephros Dual Stage Ultrafilters can be easily installed (and replaced); thus allowing healthcare facilities to eliminate bacteria, viral agents, cysts, fungi and biological endotoxins at the point of use.

An article in Business Week reports on the final EPA ruling for onboard airline drinking water.  After testing in 2004, the EPA found that airlines were not complying with drinking water regulations.  The new rule gives airlines 24months to comply with the new testing and disinfecting schedules.

The Nephros DSU, point-of-use, filter can be part of the water delivery system to filter biological contaminants well beyond EPA drinking water requirements.

Hemodialysis reimbursement is changing.  Savings on EPO, through use of ultrapure water, will allow dialysis clinics to lower their cost per treatment.  Additional benefits to the patient, from the use of ultrapure dialysate, will result in a better dialysis treatment.

Excerpts from an online article - P. aeruginosa’s occurence in drinking water is probably related more to its ability to colonize biofilms in plumbing fixtures (i.e., faucets, showerheads, etc.)

P. aeruginosa can cause a wide range of infections, and is a leading cause of illness in immunocompromised individuals.  In particular, it can be a serious pathogen in hospitals (Dembry et al. 1998)

P. aeruginosa is also a major pathogen in burn and cystic fibrosis (CF) patients and causes a high mortalitly rate in both populations. (Molina et al. 1991; Pollack 1995)

Tap water appears to be a significant route of transmission in hospitals, from colonization of plumbing fixtures.  Infections and colonization can be significantly reduced by placement of filters on the water taps.

Nephros Dual Stage Ultrafilters are available for sinks, showers, burn unit tubs and post RO/DI water treatment equipment.

PMID: 19484589 [PubMed - indexed for MEDLINE]

Rev Environ Contam Toxicol. 2009;201:71-115

1. Risk assessment of Pseudomonas aeruginios in water.

Mena KD, Gerba CP University of Texas-Houston School of Public Health, Houston, Texas, USA