Quality of water used in Palestinian hemodialysis centers

Objectives: Worldwide, hemodialysis (HD) patients are increasing every year, including Palestine. Dialysis fluid contamination due to the use of unpurified water is a common problem worldwide. Chemical and microbiological contaminants in the dialysis fluid could cross the dialyzer membrane and cause harm to dialysis patients. The objectives of this study were to evaluate the water quality used in centers in the West Bank, Palestine. The outcomes of this study will reflect the water purification system situation and come up with valuable recommendations to health decision makers. Study design: This is a laboratory-based study that covered all dialysis centers in the West Bank, Palestine. Methods: Water samples were collected from all dialysis centers, and the samples were tested chemically and microbiologically according to the standard international and pharmacopeial methods. Results: The results showed that the water quality in most dialysis centers did not comply with the minimum requirements of HD water. Microbiological contamination was detected in 12.5% of the dialysis centers. The test for chloride failed in 87% of the dialysis centers. Moreover, tests for conductivity, total organic carbon (TOC), and lead were not within the allowed limits in all the dialysis centers. Conclusions: Our study revealed evidence of chemical and bacterial contamination in the dialysis centers in Palestine. The outcomes of this study showed an urgent need for immediate steps to be taken by the concerned authorities to improve the water quality used in Palestinian HD centers. (C) 2018 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.