WATER TREATMENT

Date & Time Audit commenced

Clinic Name

Clinic Number

Address

Phone No.

Head Nurses Name

Head Nurses Email

Operation Managers Name

Operation Managers Email and Phone No.

Number of Dialysis Stations

Technical Services provided by (Company)-

Photo of the outside of the clinic
WTS SPECIFICATIONS

Brand of WTS

Make

Model

Year Installed

Is there a Accurate Flow diagram within the Plant Room

PRE-TREATMENT

Heavy Metal Raw Water Analysis undertaken in last 12 months

Does Pre-Treatment comply with ISO Standard

Are there 2 Carbon Filters

Are Carbon filter(s) correct size (EBCT-Empty Bed Contact Time) for number of Dialysis Stations

Is there a sampling port Post Carbon Filter One

Is there a sampling port Post Carbon Filter Two

Is there a sampling port Post Softener Column

Brine tank is clean inside

Correct salt in use (Vacuum Salt Tablets=Best Practice)

Brine tank - is un-dissolved salt visible

Salt stored correctly (I.e. not on floor)

Does the media/sand filter controller work

Does the Water Softener controller work

Has the resin in the softener been replaced in the last 5 years?

Does the Carbon filter 1 controller work?

Has the Carbon Media in Carbon Filter 1 been replaced in the last 2 years?

Does the Carbon filter 2 controller work

Has the Carbon Media in Carbon Filter 2 been replaced in the last 2 years?

Pressure Pre/Post Sand/Media Filter

Pressure Pre/Post Carbon Filter 1

Pressure Pre/Post Carbon Filter 2

Pressure Pre/Post Water Softener

Pressure Pre/Post Cartridge Filters

Pretreatment equipment clean & in good repair

Photo of Pre-Treatment
REVERSE OSMOSIS SYSTEM

Has RO System been Certified for use in Dialysis

Heavy metal dialysis water test annually

Audible/Visual alarm on RO - if dialysis water unsafe

Is there a nurse panel with Audible/Visual alarm on RO - if dialysis water unsafe

Electrical safety test on RO in last 12 months

Is there an RO Equipment Manual readily available

Is there a service Register/Report for RO

Have the RO Membranes been replaced in the last 5 years?

Has RO been Disinfected in last 6 Months

Reverse Osmosis clean & in good repair

Photo of Reverse Osmosis System
REVERSE OSMOSIS MONITORING EQUIPMENT

Pressure gauge pre-membranes

Pressure gauge post membrane

Raw Water Conductivity Display

Dialysis Water Conductivity Display

Rejection Display

Dialysis Water Conductivity Alarm

Rejection Alarm

Flow Meters

DISTRIBUTION SYSTEM
What type of Distribution System is installed

Is there a readily available Manual for Distribution System

Is there a Service Report/Register for the Distribution loop

NO bladder tanks in Loop System

Is RO Storage Tank bottom conical in shape

6 monthly Disinfection undertaken

UV light in the Reverse Osmosis Tank

UV lamp changed yearly

Is there 0.45 Micron Vent Filter

Cartridge Filter (1micron) in place after UV Light

STAFF WTS TESTING OBSERVATIONS

Staff wear full PPE for CFU/Endotoxins Testing

Did staff member demonstrate the correct Port for CFU/Endotoxins Sampling

Staff observed to clean port with alcohol wipe pre testing for CFU & Endotoxin sampling

Was sampling port turned on & running for Approx 2 Litres

Was tap turned off after sampling container sealed

Was Total Chlorine test performed correctly

Was Water Hardness performed correctly

DIRECTIVES & DOCUMENTATION

Documented policy on WTS Testing

Documented Work Instruction - Detailed instructions on how to undertake WTS tests

Is there a record book/ folder with all WTS Testing Results

Is there a record of Staff WTS Training

GENERAL COMMENTS ON WATER TREATMENT SYSTEM AND PRACTICES

Comments

General Water Equipment Photos

HD MACHINES

HD MACHINES

HD MACHINES ~ No. - MAKE - MODEL - AGE

Is there an Operators Manual for each HD Machine in the Clinic

4008NG & 5008 preventative maintenance undertaken each 2 Years

All prior to the above FMC HD Machine models Preventative Maintenance Annually

All other company HD Machines preventative Maintenance as per Manual

Record of Maintenance in Clinic

HD Machine mechanical condition is safe for use

Exterior casing in good condition

Rust not present on any part of machine

Power Cord Not Damaged

Machine is clean

Dialysis Water entry hose is Opaque

Dialysis Waste hose is Opaque

Annual Electrical Safety Test undertaken on every machine(EST)

Dust filter is clean (should be cleaned weekly)

DIALYSIS FLUID ULTRA FILTER

Filter installed on all machines (e.g. FMC machines Diasafe, Gambro U9000)

Filter changed every - 100 treatments, 11 degreasing Bleaches OR 3 months

Filter labelled with date of last change

LABELS ~ HD MACHINES

Machine has an ID Label

Machine has a warning label

Machine has an information label

Machine has a safety test (EST) label

WATER CONNECTORS

Machine WTS Connector is installed on external Media Panel not inside a cupboard

Does drainage have Air Gap

PORTABLE RO

PORTABLE RO

Number - Make - Model - Age

Maintenance undertaken as per Manufacturers recommendation

Records of all maintenance kept In Clinic

Operators manual for every Portable RO

Is Portable RO clean

Annual Electrical Safety Test (EST) undertaken

PORTABLE WTS DISINFECTION

Disinfection undertaken every Month (BEST PRACTICE)

Disinfection undertaken every 3 Months

Disinfection undertaken every 6 Months

Disinfection undertaken every 12 Months

Documentation of disinfection available in Clinic

PORTABLE WTS PRE FILTRATION
Carbon Cartridges replacement

Media Cartridge

Softener in place

Carbon Filter

Cartridge Media Filter

Is the amount of Carbon adequate (10 EBCT)

Carbon Media replacement
PORTABLE WTS WATER TESTING

Testing for CFU & Endotoxins undertaken every 3 months

Records of Results available in Clinic

Photo of Equipment

WEIGHING SCALES

WEIGHING SCALES

Number - Make - Model - Age

Maintenance undertaken as per Manufacturers recommendation

Records of all maintenance kept In Clinic

Operators manual

Annual Electrical Safety Test (EST) undertaken

Reprocessoring Equipment

Reprocessing Equipment

Model, number, age

Maintenance undertaken as per manufacturers instructions?

Records of service?

Records of Dialyser reprocessing?

Equipment operating manuals?

Annual Electrical Safety Test (EST) performed?

Is the reprocessing room well ventilated?

Is there Material Safety Data Sheet (MSDS) in the reprocessing room?

Is there Personnel Protection Equipment (PPE) available for staff?

Are the staff using PPE during reprocessing?

Photos of reprocessing room and equipment.

Concentrate Mixing

Concentrate Mixing

Manufacture, Model, Age

Is the Room Clean?

Is the Equipment Clean?

Is the Room Ventilated?

Are MSDS Information readily available for all chemicals?

Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.