Research Progress on Sanitary Quality And Management Standardization of Medical Water

Research Progress on Sanitary Quality and Management Standardization of Medical Water

As a crucial support for diagnostic and therapeutic activities in medical institutions, the sanitary quality of medical water is directly related to patient safety and medical service quality. Currently, medical water in China covers multiple fields such as hemodialysis, dental treatment, medical device cleaning, and airway humidification. Water quality requirements vary significantly depending on the application; however, issues like inconsistent management standards and insufficient technical support are prevalent, calling for systematic optimization.

Hemodialysis water is a key focus in medical water management. A dialysis device may come into contact with over 300 liters of water per week for a patient, and its water quality directly affects the risk of complications such as hemolysis and anemia. Monitoring data from the Hunan Provincial Center for Disease Control and Prevention between 2003 and 2011 showed that the qualification rates of total bacterial count and endotoxin in hemodialysis water were only 70.3% and 41.7% respectively. The main pollution sources include defects in the water treatment system process, inadequate equipment maintenance, and poor inter-departmental collaboration. Although China has implemented the YY0572-2015 standard, which lowers the endotoxin limit to 0.25 EU/mL, microbial control remains a major industry challenge. There is a need to strengthen the whole-life-cycle management of water treatment equipment and establish a closed-loop system from raw water treatment to end-point monitoring.

The problem of microbial contamination in dental treatment water is particularly prominent. A 2002 study by Jiang Ning et al. on 187 medical institutions revealed that only 62.89% of samples met the drinking water standards, with qualification rates of water storage tanks and handpiece outlets below 60%. The main causes include the formation of biofilms in water circuits, back-suction contamination of instruments, and the lack of dedicated standards. Currently, the industry mostly references the GB5749-2006 standard, which fails to account for the specific characteristics of dental water circuits. There is an urgent need to formulate targeted specifications, while promoting intelligent flushing systems and regular biofilm removal technologies to reduce the risk of cross-infection.

Quality control of water for medical device cleaning faces dual challenges of equipment and standards. Although the WS310 series of specifications require the conductivity of final rinse water to be ≤15 μS/cm, there are no provisions for soft water indicators or microbial limits. Surveys indicate that central sterile supply departments often experience instrument scaling due to improper selection of water treatment equipment, which affects sterilization effectiveness. It is recommended to improve domestic specifications by drawing on international standards, establish threshold values for key indicators such as water hardness and heavy metals in cleaning water, and promote the adoption of regional centralized water supply models in primary medical institutions to alleviate the pressure of equipment investment.

The pollution status of water for airway humidification is worrying. Clinically, distilled water or cooled boiled water is commonly used as humidifying fluid; however, 57% of samples have excessive microbial counts, with a relatively high detection rate of opportunistic pathogens such as Pseudomonas aeruginosa. Although humidifying fluid provided with oxygen humidifiers can reduce the risk of contamination, there is no unified standard for the storage time limit of backup water. It is necessary to clarify the sterility requirements for humidifying fluid, establish a dynamic monitoring mechanism, and promote the use of disposable humidifiers or intelligent humidification systems with self-purification functions.

The management of water for pharmaceutical preparation shows a polarized trend. Pharmaceutical preparation rooms in large medical institutions generally implement the standards specified in the Chinese Pharmacopoeia, while small-sized institutions rely on externally purchased sterile water for injection, which poses supply chain risks. With the increase in the variety of marketed drugs, the demand for water for pharmaceutical preparation has gradually decreased; however, special varieties such as traditional Chinese medicine preparations still require standardized management of process water. It is recommended to establish a dynamic evaluation mechanism for water used in pharmaceutical preparations and explore the sharing of water treatment facilities for low-demand varieties to reduce operating costs.

The prominent common contradictions in medical water management are reflected in three aspects:

At the institutional level: The design, maintenance, and monitoring standards for water supply systems are fragmented, and there are supervision blind spots in secondary water supply facilities.

At the technical level: The allocation of operation and maintenance personnel for water treatment equipment is insufficient, and 42% of institutions outsource operation and maintenance work, leading to delays in disposal and response.

At the standard level: Except for hemodialysis water and water for pharmaceutical production, there is a lack of special specifications for other types of medical water, resulting in inconsistent monitoring indicators and frequencies.

It is necessary to build a hierarchical management system, incorporating high-risk water such as hemodialysis and dental treatment water into key monitoring, while conducting regular sampling inspections for general medical treatment water. Meanwhile, an inter-departmental collaboration mechanism should be established to include water quality monitoring in the assessment indicators for hospital infection prevention and control.

Smart technologies provide a new approach to medical water management. The First Affiliated Hospital of Wenzhou Medical University has reduced the water leakage rate from 3% to 1.5% and achieved an annual water saving of 62,000 tons by dividing the hospital into 35 independent metering zones and deploying NB-IoT smart water meters and BIM (Building Information Modeling) pipeline network models. In the future, it will be possible to promote online water quality monitoring platforms, integrating real-time early warnings for parameters such as conductivity, residual chlorine, and microorganisms. Combined with artificial intelligence to predict changes in pipeline pressure, the management model can shift from passive maintenance to active prevention and control. Regional medical groups can establish central water treatment centers and realize coordinated water quality management across multiple hospital campuses through the Internet of Things, thereby improving resource utilization efficiency.

Medical water safety is a systematic project that requires coordinated advancement in three aspects: standard improvement, technological innovation, and management optimization. It is recommended to accelerate the formulation of the Sanitary Management Specifications for Medical Water in Medical Institutions, clarifying water quality indicators and monitoring frequencies for different uses; promote the intelligent upgrading of water treatment equipment and establish a qualification certification system for operation and maintenance personnel; and build a water quality risk early warning network, incorporating waterborne infections into the performance evaluation of medical institutions. Only by forming a full-chain closed-loop management can waterborne infections be effectively prevented and controlled, and medical quality and patient safety be safeguarded.