CCHT Water Treatment and Quality 3

Question 1

A dialysis patient develops aluminum toxicity. Which water treatment failure is the most likely cause?

Accepted Answer

Inadequate removal of aluminum from the source water by the RO system

Answer

Failure of the water softener to remove calcium

Answer

Chloramine breakthrough from an exhausted carbon filter

Answer

Failure of the ultraviolet light sterilization unit

Question 2

What is the purpose of testing dialysis water for endotoxins?

Accepted Answer

To detect bacterial cell wall fragments that can cause inflammatory reactions even in the absence of live bacteria

Answer

To confirm the water is free of aluminum and heavy metals

Answer

To measure the total dissolved solids that might interfere with dialysate mixing

Answer

To assess the effectiveness of chloramine removal by the carbon tanks

Question 3

During a water quality check, the RO product water conductivity reading is 45 μS/cm, significantly higher than the baseline of 8 μS/cm. What does this most likely indicate?

Accepted Answer

The RO membrane is failing or bypassed, allowing solutes to pass through into the product water

Answer

The softener has been regenerated and is releasing excess sodium temporarily

Answer

The carbon tank is exhausted and releasing chloramine into the RO feed

Answer

Normal seasonal variation in source water mineral content

Question 4

What is the function of the distribution loop in the dialysis water treatment system?

Accepted Answer

To continuously circulate RO-purified water to dialysis machines, preventing stagnation and bacterial growth in supply lines

Answer

To distribute concentrated electrolytes from the proportioning system to individual dialysis machines

Answer

To recirculate used dialysate back through the RO system for reuse

Answer

To distribute backwash water from the RO reject stream to the floor drains

Question 5

What type of water quality testing documents are required to be maintained in the dialysis facility?

Accepted Answer

Daily chlorine/chloramine logs, monthly bacteriology and endotoxin results, and annual chemical analysis, retained for at least 2 years

Answer

Only monthly bacteriology reports are required by CMS

Answer

Water test results are maintained only by the water treatment vendor and not required on-site

Answer

Only the annual state inspection water quality report is required

Question 6

A dialysis facility's monthly water culture result shows a bacterial count of 75 CFU/mL. What action is required?

Accepted Answer

This exceeds the action level (50 CFU/mL) and requires investigation, corrective action, and resampling

Answer

No action needed; this is within AAMI acceptable limits

Answer

This exceeds the maximum limit (200 CFU/mL) and patient treatments must be halted immediately

Answer

Increase the frequency of water testing to weekly and continue patient treatments