Need some help folks, here's the situation...

New unit to be opening soon...pointed out the following in this BRAND NEW UNIT....only thing so far is the water treatment pipes, acid pipes, and bicarb delivery pipes....all are continuous flow piping....

Water treatment pipes have all 90 degree piping, no 45's even though this could have easily been put in...inside of pipes where glued together are not beveled at all, just glued and stuck in....to reach the machines there will be a 90 degree turn with a 4-6 inch connecting pipe where stagnation can occur...the pipes slope here and there in the walls, here and there over and over...no guaduation or slow sloping throughout the system...Bicarb system is exactly the same.....No consultation with other outside dialysis related companies....only readiong or seeing as they see fit...I pointed this all out to them before they closed the walls and they said it meets code, which it might but I doubt...yet I know the final product will probably be.... I need others to fill in the blanks so I know I'm not nuts...please help so I can decide if I should pursue this further....I do not want to put my input in, insttead I need yours...SO PLEASE HELP..what outcome do you seee????

Call and talk to Jim Baker at AmeriWater. He is extremely knowledgeable in dialysis water treatment and will be happy to discuss this with you. 800-535-5585.

www.florianservices.com
He posts in here quite frequently and I'm sure he will have alot to recommend to you. Many problems can be avoided down the line, if they are adressed at an early stage. Quite frankly, it sounds like a bunch of "plumbers", and I mean that in the most derogatory way, did your design and installation. I've seen poor planning, that could have been easily adressed, create poor outcomes when everything becomes operational. Good luck, and don't let the bastards win.

Diane- Do you work for Ameriwater? I notice your post are like a sales pitch....

The truth is ANY major water company can help you, Better Water, Marcor, etc.... I would suggest talking with the company you are purchasing your water system through.

Plumbers do not get it. Next time see use a water system manufacturer that also does loops. They understand the needs of the dialysis facility. I know that Better Water does loops and manufactures the water equipment. Not sure about Marcor or Ameriwater

90 or 45, all 90 could be bad i think, bateria build up at the corner. 45 gives u more connections to build up bateria, less conections better. Did they cut pipe with pipe cutter or hacksaw? hacksaw very bad. bevel not done means bad edge. I dont think there mistake was what they did as much as the worse thing that could happen, not asking the biomed what to do. Same thing here with reconstruction i am the last asked and the only one that knows. They should have asked u and listened. More 45, few 90, no hacksaw, bevel, short as possiable tee off(no 4 to 6 inchs), should be level as possiable, most all these things are listed in the AAMI book.

I have a MAR-COR water system, they did all the piping at 45degrees plus for monthly disinfection on both loops ( technical and clinic) it easy rinse out.

jdbiomed - Thanks for the plug.

The plumber is correct; your system was installed per code. Unfortunately, code does not require it to be installed per AAMI. One way I have found to combat this is to put the AAMI instructions on the blue prints...probably too late for you. I have scared a few plumbers away by saying they are not FDA approved. Some union plumbers can be very difficult. They think that as long as they have a license, then they can do the job. Many of the dialysis water companies don't use licensed plumbers but they have been trained on AAMI. There are probably a few hundred clinics (if not thousands) in the same situation as you.

AAMI RD52 section 7.1 gives the best description of how a loop should be constructed to mimize bacteria proliferation.

90 degree elbow are not a big problem. They will cause a larger pressure drop across your loop, slowing down the water velocity. This can impact the AAMI requriement for a minimum 3 ft/sec flow velocity (indirect feed) or 1.5 ft/sec (direct feed) (AAMI RD52).

RD52 also states "Dead-end pipes and unused branches and taps that can trap fluid should be eliminated because they act as reservoirs of bacteria and are capable of continuously inoculating the entire volume of the system." I have defined a dead-leg as anything longer than 1.5 times the pipe ID. Every station will probably have a dead-leg. The hose to the dialysis machine is a dead-leg when the machine is not in use. To combat this, you may need to run a brush through the piping at each station. I have gotten long brushes from a pet store in the aquarium section. I would clean the inside of this piping with the brush every month during your monthly disinfection.

Also, "Joints between sections of piping and between piping and fittings should be formed in a manner that minimizes the formation of crevices and other voids that may serve as sites for bacterial colonization." "Pipes should not be cut with a hacksaw." "Any burrs should be removed before the joint is formed." And, "water distribution systems should be configured as a continuous loop and designed to minimize bacterial proliferation and biofilm formation" All of these quotes are from AAMI RD52.

The purpose of these statements in AAMI is to help minimize bacteria and biofilm formation. Biofilm forms in the dead-legs, crevices left inside the joints, collect on the burrs left on the piping, etc. The other way to control bacteria and biofilm is with a good disinfection routine (at least monthly).

The other option is to install endotoxin filters at each station to better protect your patients. If you are using the Fres K machine, you can use their Diasafe filter.

Call me if you need further information.