Biologically Safe Water Filters

The Agency for Healthcare Research and Quality (AHRQ) has recently released a report showing that adult patients with health care associated infections had to stay an average of 19 days longer in the hospital than those adult patients who did not develop HAI’s.  The average cost of treating these patients was $43,000 more expensive than treating those without HAI’s.  Ultrafilters are one means of dealing with infection issues.

Under CMS’ new hospital inpatient prospective payment system, final rule for fiscal year 2011, hospitals must report central line associated bloodstream infections every 3 months.  The data will be posted on the Hospital Compare website.  Many states already require reporting (21 states).

The rules for financial penalties to hospitals with HAI problems are being developed.  The solution to HAI’s will require changes in operational protocols and the environments of care.  The continued over-use of antibiotics will not solve infection costs.  As HAI data is made public, patients will choose where to have surgery, etc.  Hospitals will have to solve this problem in the near future since they will have to pay for the costs associated with the infection. A recent article, One Superbug Infection Costs Hospital $60,000 pertains to surgical related infections.  Catheter related bloodstream infections (CRBSI) can go as high as $90,000 and are thought to be more prevalent than surgical related infections.

The Nephros Dual-Stage Ultrafilter has a .005 micron membrane 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.

AAMI microbiological standards for acute and home dialysis are changing.  The current standard is less than 2 EU/mL of endotoxin units and the proposed standard is less than 0.25 EU/mL with a proposed action level of less than 0.125 EU/mL.

The current standard for Coliform Forming Units is less than 200 CFU/mL and the proposed standard is less than 100 CFU/mL with a proposed action level of less than 50 CFU/mL.

The Nephros DSU will help achieve these lower levels.  The .005 micron pore size of the DSU wll provide up to 12 months of protection.  Use the DSU on water lines, prior to entering the dialysis machine.

This final filter can withstand multiple disinfection cycles.  The Nephros DSU can provide the protection needed on portable RO machiines that have bacteria build-up do to infrequent use.  The DSU also provides protection for RO water loops where bacteria/endotoxins can colonize in the water loop.

The Association for the Advancement of Medical Instrumentation (AAMI) Renal Disease and Detoxification Committee has approved the integration of Standard RD52 with the new ISO-23500 International Standard.

Many dialysis facilities that utilize portable RO’s will have to work harder to meet the new AAMI standards.  The new standard will lower the recommended tolerable endotoxin levels for water used to make dialysate.

The Nephros DSU is an ultrafilter (.005 micron) that provides additional filtration to meet the new AAMI standards.  The DSU can be installed on individual RO/DI machines - and also on central water and bicarb loops.

Hospital water sources need to be filtered in order to reduce hospital acquired infections (HAI’s).  Removing dirt/debris and debriding eschar requires water that will minimize the bio-burden in the wound. 

Filtering hospital water just prior to patient use (showers, sinks, whirlpools, etc) reduces the risk of infection.  The Nephros DSU is a .005 micron filter (most other filters are .02 micron) that should last about 3-6 months depending on usage.  The filter is easy to change, using quick disconnect couplings.  The Nephros DSU is a cost-effective solution to waterborne infections.  See specifications.

Potential sources of waterborne organisms can be found throughout hospital water systems; in faucets, showers, water used for respiratory therapy, ice machines, etc.  Many aquatic microorganisms can survive and flourish in water with minimal nutrients and can be transferred to vulnerable hospital patients directly (e.g., inhalation, ingestion, surface absorption) and indirectly (e.g., by instruments and utensils). 

HAI’s (hospital acquired infections) are the second largest patient safety issue that healthcare organizations face every day. More than 90,000 patients die annually.  The financial burden is escalating: Nearly $20 billion in avoidable costs and lost revenue.  Today, more and more states are requiring that organizations report HAIs; and with lower Medicare reimbursements on the horizon, it is now time to take a new look at your own approach to HAIs.

The Nephros DSU has a .005 micron membrane that can filter out biological contaminants, thus reducing the incidence of HAI’s. 

A number of dialysis clinics are developing high bacteria counts in their water for patient treatments.  Bacteria from the carbon tanks is mostly removed by the RO.  The RO is not 100% effective though, therefore; to protect the patient, all acute dialysis machines should have an ultrafilter.  An excellent discussion on this issue can be found on RenalWeb.  The Nephros DSU can provide the protection needed for portable RO machines in the acute and home hemo dialysis settings.

Water is the main source of contaminants in dialysate.  A presentation by Jo-Ann B. Maltais, Ph. D. at the NANT 27th Annual Symposium, March 3, 2010 discusses the contaminants in dialysis water.  Dr. Maltais highlights why we should use ultrapure dialysate and the long-term effects of chronic micro-inflammation on dialysis patients.  She gives evidence to support improved clinical outcomes using ultrapure dialysate.

The presentation also provides guidance for technicians regarding what systems can be used and how to validate them.  The Nephros DSU has an FDA 510K.  The .005 micron ultrafilter makes it a cost-effective component in the process to achieve ultrapure dialysis.

Water and dialysis fluid of high microbial purity reduce the inflammatory stimulus in patients.  This can result in improved responsiveness to erythropoietin (EPO).  The patient can then receive the same EPO benefits with less EPO.  See article.

Incorporating the Nephros DSU into the water and bicarb lines will allow dialysis providers to reduce endotoxin levels and treat their patients with ultrapure dialysate.  Significant savings in the use/cost of EPO can be achieved through the use of the Nephros DSU.

William Costerton, PhD, spoke at the 30th Annual Dialysis conference (ADC) in Seattle and provided an excellent site that highlights the problems of biofilm in medical water systems.

Dr. Costerton indicated that biofilms are present in 80% of infections.  Biofilms can cause infections in ICU’s, Burn Units, and Dialysis; plus, they can be found in dental unit water lines.  Biofilms have even been found attached to a patient’s pacemaker.

The Nephros DSU is a .005 micron filter - which can filter out these biofilms.  Expected life span is approximately 3 months on a standard faucet and 1 year when used post RO (reverse osmosis).