Boil Order

[Rerun]

My friend is on Home NxStage.  They have a boil order for their water because Ecoli tested positive in their water district.  I know she was boiling her drinking water 3 to 5 minutes and they were told not to shower with tap water, brush their teeth etc.  So when I asked her if they were using bags this week she said no they called the center and since the water doesn't mix with the blood they were okay.

Really?  Then why test your water at all?  If it has tested positive for Ecoli and you can use it for dialysis!!  Is it because the bacteria of Ecoli is too big to ever cross the fibers like water molecules are too big but potassium can cross over because it is a smaller molecule?

I would just use the bags.  Why chance it.

The boil order is over now and she is fine.  This has just been on my mind.

[Jean]

 I don't know, but it certainly sounds weird. I hope you will let us know if you find out.

[willowtreewren]

The NxStage system has a robust water purifier that has multiple steps of purification. I don't think your friend was in any danger.

[Charlie B53]

I am on PD, haven't yet had to go to Hemo. But when or IF, I do you can be sure that I would not risk using even possibly contaminated water.  I far rather err on the safe side than risk allowing any bacterial infection directly into my blood.

I am on a well, shared with 6 other homes.  John has the water tested regularly.  For the 18 years we have lived here, so far so good.  Our water does have a lot of mineral, being  in the mid-west a lot of desolved limestone.  I use a 10 mic whole house filter then a water softener.  At the kitchen sink I installed an RO unit so there is a third tap at that since for RO water.  It really saves cleaning the coffee maker.

I do sometimes wonder about installing some sort of UV purifier just in case there is ever any bacterial found in our water.

But I certainly agree with Rerun, if there is ever any doubt, use the bags just to be sure.  It isn't worth the risk.

[Hemodoc]

Wow, no system is perfect or foolproof. Boil order here, it is bags for sure. E. Coli kills quickly and is difficult to treat. Gram negative sepsis is not a fun game to play at all.  That peeks my interest Rerun on what the standards for dialysis centers is in that situation using NxStage at home. That doesn't sound like the right advice to me. I will see if there is anything online about this issue.

[Rerun]

Maybe you heard it on the news Peter.  The Pondarosa Water system north of the Spokane River was on Boil order.  My friend's water system.  I'm south of the river and on Irvine Water system.  But, they used the water and grant it, she is still alive so it obviously didn't hurt her.  But the home dialysis nurse told her that her blood didn't mix with the water so she was fine.  Really?  Well why the monthly testing at all then?  Ecoli?  Really?

[Hemodoc]

Maybe you heard it on the news Peter.  The Pondarosa Water system north of the Spokane River was on Boil order.  My friend's water system.  I'm south of the river and on Irvine Water system.  But, they used the water and grant it, she is still alive so it obviously didn't hurt her.  But the home dialysis nurse told her that her blood didn't mix with the water so she was fine.  Really?  Well why the monthly testing at all then?  Ecoli?  Really?

I didn't find a specific reference to temporary boil orders, but bacteria levels in water is one of the monthly tests. The tolerances for clearing endotoxins is not limitless.

Secondly, the dialysate does mix with the blood. It is called backflush. Sadly, that is the extent of knowledge more often than not.

Hope all is well Rerun. God bless.

[Charlie B53]

The primary reason for a boil order is to make the water safe for human consumption, drinking, witihout any bacteria that can start a problem if consumed.

Contaminated water may still be safe for bathing.  And may still be safe for cooking those dinner items that are heated to at least 195, like boiling a pot of noodles at 212, all bacteria would be killed.

I would be concerned about a Hemo filter being cleaned with such water.  Bacteria could remain within the filter unless a sterilizing agent is use to flush and purify the filter.

She may be fine this time, but I would not recommend this be repeated if another boil order ever comes along.

Play it safe, use the bags, unless you have some type of back-up purification system.

[amanda100wilson]

The water is purified before it gets to the filter;  by the time it gets out of the Pureflow Machine, it should already be clear of bacteria by then.  That being said, I am not sure that I would either just use bags or ask NxStage directly if it would be safe (I am sure the answer would be 'no')

[Rerun]

Peter it was the Pasadena water system not Pondarosa sorry.

[obsidianom]

I am not advocating using the water but here is an interesting fact . The filter on the Nxstage Pureflow that is the final filter before the dialysate gets into the system has a 1.2 micron size. ( it is stamped right on it).  Now the typical ecoli bacteris is bigger at around 2.0microns.  See the following:
'
"Cells are typically rod-shaped, and are about 2.0 micrometers (μm) long"   (e-coli)

So theoretically it shouldnt be allowed to pass the filter into the cassette and would never reach the  cassette kidney where the blood is. 
 

[amanda100wilson]

If they are rod-shaped, then their diameter must be smaller than the filter size, so that must mean that they can slip through lengthwise?

[obsidianom]

If they are rod-shaped, then their diameter must be smaller than the filter size, so that must mean that they can slip through lengthwise?

Perhaps but not sure.
This got me thinking. Many of us have well water for our source. That water comes from the ground and is full of bacteria. It is UNTREATED. That is what we have. Its just ground water about 20 feet down in the ground in our case. The ground is full of bacteria.
Now the Pureflow system has the ability to kill bacteria via its various systems including UV light. We test ours every 3 months for the past 2 years and there are NO bacteria in the water or the dialysate after the pureflow treats it.  So in a way it is the perfect sanitising system. It can take our ground water and make it sterile. We culture it to test it.
So the bottom line is why would a few ecoli be a big deal? They should easily be killed by the system. It is designed for that. Its like the autoclave I use to sterilize my surgical instruments. I use instruments on infections such as staph yet the autocalve sterilizes them perfectly to reuse. Bacteria are everywhere. The ecoli in the boil order are just 1 more bacteria that can be killed by a proper sanitising system and pureflow does that.
I am willing to listen to other opinions on this as I dont seem to see the big deal.   If we cant trust the system in pureflow than why are we using it ? It either works or doesnt. So far in over 12 tests on my well water that it purifies from the ground it is perfect. No growth EVER.

[Charlie B53]

Having a UV treatmant is great, unfortunately not many have that at home.  Like my whole house filter, I use the 'fine' filter which is (I believe) only 10 mic, most filters are 20 to 50.  Not much good for bacteria.

I've thought about a UV source, just haven't looked into it yet as the lab tells us our well is fine.

So good that the local water company keeps pestering us to sell it.  They claim we will have 'free' water as long as we live here.  But I don't think I want to turn over our well and let them 'put stuff' into my water.

Our well is down about 100 ft, the water has risen up to about the 450 mark from the deep aquafer.

I like it just the way it is.  Knock on wood.