I have a quick question concerning action needed on a water room upgrade.
We currently have a water system that is in desperate need of repair. We have finally gotten approval to replace the RO and storage tank with one from another facility (that facility was shut down earlier this year because of lack or patients). We are having the RO membranes replaced, bench tested and cleaned prior to its installation in the new facility. Does anyone know what CMS requires as far as cultures, endotoxins and AAMIs before we allow patients to run on the new water treatment equipment? I had already planned on having cultures and endotoxins drawn on the RO while it is in the shop. My concern is that although the complete system is not being replaced (the loop other than the holding tank is not being modified) CMS is going to require to have negative cultures and endotoxins before we run patients. The clinical manager does not want to disrupt the patient’s treatment schedule more than necessary. PLEASE any advice on this matter would be greatly appreciated.

i would suggest you use your DI system until your cultures come back , the endos can be done in one day but you will need 48 hours for the cultures. also take endo and micros weekly or more until you can establish a trend. The AAMI's can be done monthly than go to your quarterly schedule.
same goes for you loop with the new tank.

Best bet give your state CMS regs a read, or call your friendly state inspector for a copy of requirements. Try Googlin ESRD regulatory requirements for your state.

You will need to run cultures and endotoxin tests after installation, as suggested earlier use DI as long as it has a DI Divert system on it and endotoxin filters until the results come back. I also agree that you should draw weekly cultures and endotoxins for 4 weeks to confirm results.

Yeah you should talk to your R.O company about installing a D.I. board with a D.I system and maybe use tygon tubing to supply the machines. You should have the multimedia, carbon and softener in place and tie the D.I. into that and have it split to go to your R.O also...that way you can run patients and have your R.O running the whole time also. This way if you have bad cultures you can repeat them and have time for them to come back.Since you need cultures for the whole sytem "closed" or as a whole, you can not use any part of it until the cultures come back which is why you need a whole seperate system to run the machines on whle you wait for cultures.

New RO or new membranes seems to be the same question comes up. Here's my thoughts. A good running RO (rejection >95%) is first a bacteria barrier and the biggie is the endotoxin barrier. If at all possible, I prefer too polish the RO with DI until the AAMI chemical results come back. If you bypass the RO then the only barrier inplace is the Ultrafilters. If the rejection on the new RO or Membranes is correct, why not use the additional barrier? Does anyone pull frequent LAL's to challenge the ultrafilters when the RO is bypassed? Just thoughts.