Resources - Tranzform Water

Ensuring Purity: Why Every Drop Matters in Dialysis

by Rio Ocampo November 17, 2025

Photo from Dialysis Patient Citizens Education Center

When a patient undergoes hemodialysis, the water that underpins this life-saving therapy isn’t just “clean” — it must be ultra-pure, because every liter counts and the margin for error is extremely small. Unlike drinking water, which passes through the gut and other body systems that filter out many contaminants, dialysis water can come into near-direct contact with the patient’s bloodstream via the semi-permeable dialysis membrane.

Why Trace Contaminants Matter in Dialysis

Volume and direct exposure
In a typical hemodialysis session, a patient may be exposed to 120-200 liters of water (via the dialysate) in a single treatment.

Lack of normal renal clearance
Dialysis patients generally have little to no kidney function. That means many contaminants that a healthy person might eliminate are no longer removed efficiently.

Semi-permeable membrane & diffusion risk
The dialysis membrane is designed to allow diffusion and ultrafiltration of waste products from blood into dialysate. But the flip side: small molecular-weight or ionic contaminants in the water/dialysate may diffuse back into bloodstream, or at least have a route of exposure.

Clinical consequences are real
Various chemical and microbiological contaminants have been liked with acute and chronic adverse events: hemolysis, bone disease, encephalopathy, inflammation, pyrogenic reactions.

For instance:
Elevated aluminum in dialysis water → bone disease, encephalopathy, anemia
Chloramine/chlorine breakdown products → hemolytic anemia
Bacterial endotoxins in dialysate → inflammatory responses, pyrogenic reactions.Because of this, dialysis water treatment must adhere to far stricter standards than typical drinking water quality.

Is Your Dialysis Center’s Water System Safe, Compliant, and Reliable?

Hemodialysis requires ultrapure water to ensure patient safety and equipment longevity. Any compromise in water quality can lead to serious health risks and costly operational downtime.

Whether you’re starting a new fcility or upgrading an existing one, we provide specialized water treatment solutions tailored to dialysis centers. Our systems are built to meet DOH standards and ensure uninterrupted, safe treatment—even during supply disruptions.

Ready to take the next step? Fill out our contact form and let our experts guide you toward a safer,more reliable water solution for your dialysis operations.

November 17, 2025 0 comment

Dialysis

From Source to Dialyzer: The Journey of Water in a Dialysis Unit

by Rio Ocampo November 12, 2025

Photo from American Kidney Fund

Stage 1: Feed Water — The Starting Point
The process begins with municipal or deep-well water, which may contain impurities such as sediments, chlorine, and dissolved minerals. Before entering the dialysis circuit, this water must be purified to protect both the system and the patient.

Stage 2: Pre-Treatment
Through multimedia filtration, activated carbon, and softening units, the feed water is stripped of particulates, chlorine, and hardness. The initial conditioning phase ensures the reliability and longevity of downstream components.

Stage 3: 2 Pass Reverse Osmosis (RO)
At the heart of the system, reverse osmosis employees semi-permeable membranes to remove up to 99% of dissolved ions, organics, and other contaminants, producing high-quality permeate water suitable for dialysis applications.

Stage 4: Deionization/Electrodeionization (EDI)
To achieve ultrapure quality, the RO permeate is “polished” through deionization or EDI systems, which remove remaining ionic traces, achieving the conductivity levels mandated by dialysis water standards.

Stage 5: Distribution Loop
Purified water circulates continuously within a sanitized distribution loop, maintaining consistent quality as it is continuously filtered through an ultrafilter & UV preventing stagnation and biofilm formation until it reaches the dialyzer.

Delivering Life-Saving Purity

Every stage in this process is vital — not just for compliance, but for the protection and well-being of every dialysis patient. A well-designed system will ensure >99.99% (log 4) bacteriological removal.

Is Your Dialysis Center’s Water System Safe, Compliant, and Reliable?

Hemodialysis requires ultra-pure water to ensure patient safety and equipment longevity. Any compromise in water quality
can lead to serious health risks and costly operational downtime.

Whether you’re starting a new facility or upgrading an existing one, we provide specialized water
treatment solutions tailored to dialysis centers. Our systems are built to meet DOH standards
and ensure uninterrupted, safe treatment—even during supply disruptions.

Ready to take the next step? Fill out our contact form and let our experts guide you toward a
safer, more reliable water solution for your dialysis operations.

November 12, 2025 0 comment

CSSD

Intelligent Water Solutions for CSSD

by Titus October 30, 2025

Central Sterilisation Services Department (CSSD)

Central Sterilisation Service Department (CSSD) play a crucial role in hospitals by ensuring the highest level of hygiene for medical devices, thereby safeguarding patient safety.

To achieve this, these units employ advanced water purification technologies such as reverse osmosis, ultraviolet sterilisation, and deionization.

These processes effectively eliminate microorganisms, contaminants, and other impurities from the water supply.

By utilising highly purified water, CSSDs extend the lifespan of medical instruments, enhance the efficacy of sterilization procedures, and significantly reduce the risk of healthcare-associated infections.

Furthermore, water purification systems not only modify the physical properties of water but also its chemical composition, resulting in safer and more efficient sterilisation processes.

Tranzform Waters – “Clean Water, Patient Safety!”

To learn more about how Tranzform Water can enhance your hospital’s sterilisation processes, book a consultation with our experts today.

Click the button to contact us and discorver how Tranzform Water can help you achieve safe, reliable, and compliant sterilization.

October 30, 2025 0 comment

CSSD Medical

Key Elements in Planning and Designing For CSSD Water Treatment

by Titus October 27, 2025

Key Information to be gathered during for the preliminary assessment:

Details of each washer/sterilizer/tap that requires CSSD water feed water quality & type
Volume of CSSD water quality type required per cycle per unit
Number of cycles per hour and hours per day, per unit
Draw rate of the equipment when filling per unit
Future growth expansion (Design for allowance)
Feed water quality (full analysis) and pressure to the plant room
Ideal location – accessibility, power, water & drains
Ring main temperature preference and heating method
Existing ring main details and/or access for new ring main
In-house capabilities (personnel/roles experience to maintain and operate)
BMS and remote monitoring requirements

Doing the groundwork exercise to gather the required information, helps to ensure a successful and smooth implementation of the suitable water treatment solution for your CSSD.

Feel free to contact Tranzform Waters to learn more about the solutions we can offer.

October 27, 2025 0 comment

AS 5369 CSSD Medical

Thermal Disinfection of Water Treatment Systems for Hospitals

by Titus October 23, 2025

Key Points to Note:

Ensuring sound design and implementation of water treatment systems in hospitals are paramount importance for high quality of patient care in the CSSD and dialysis departments as well as meeting compliance requirements.
Maintaining disinfection water temperature at 80°C for 1 hour, is important minimise bacterial colonisation and ensure effective thermal disinfection outcomes.
Operating at temperatures, designing the loop distribution length, and the heat transfer of thermoplastics versus stainless steel is important for good water treatment system performance and preventing microbial growth.
Successful system design must meet the requisites to ensure sustained compliance. disinfection processes, such as thermal disinfection, to protect both patient and ensure staff operating the system. Dispelling common misconceptions is essential for proper practices.
Below are some of them:

	Wrong	Correct
1	Operating CSSD RO systems at 65°C eliminates the need to maintain temperatures between 80°C and 90°C during disinfection.	While operating at 65°C, bacteria can still grow/survive in piping networks. Therefore, there is a need to maintain water temperature at 80°C for a minimum of 1 hour for achieving effective disinfection outcomes
2	Achieving the required A0 value of 12,000 is independent on the overall length of the distribution loop.	Even with insulated pipes, temperature loss is different with distribution loop length. Bacteria in biofilm matrices can adapt to lower temperatures and build resistance over time, leading to microbial growth.
3	Stainless steel is a good heat conductor, therefore thermoplastics being able to retain heat can achieve better thermal disinfection outcomes than stainless steel.	Stainless steel’s higher thermal conductivity enables more effective heat penetration into the biofilm matrix during thermal disinfection processes compared to thermoplastics. This ensures thorough heating of the entire system, including the biofilm on pipe surfaces, to the required temperature for disinfection. The heating energy required for SS and PVC piping is almost equivalent.

Ensuring accurate and good system design will prevent costs caused by risks to patient health, operational downtime, tarnished good reputation and lead to early RO system replacements.

Loop Heat Disinfect Features:

Easy step through programming (7 day program)
Program syncs with the Heat Sanitisation smart controller
Intelligent monitoring routines, leak detection, and over use
Heat disinfect will abort if leak is detected
Two levels of password protection
Event log holds up to 12 months of data required end of loop history
USB download to Excel
Stainless steel skid complete with insulated stainless steel storage tank with sloping base fitted with three heating elements to minimize electrical consumption, level transmitter and temperature monitor
Stainless steel recirculation pump, stainless steel solenoid valves

If you’re looking to elevate your facility’s water standards, you’ve come to the right place. Let us help you achieve industry compliance while enhancing operational efficiency. Simply fill out our contact form, and one of our specialists will guide you through the process of transforming your water quality.

October 23, 2025 0 comment

Dialysis

Structure and Key Elements of a Water Treatment System for Hemodialysis

by Rio Ocampo October 15, 2025

System Overview of a Water Treatment System

Ensuring the delivery of ultrapure water in hemodialysis facilities is critical for patient safety and clinical effectiveness. The following describes a typical water treatment system configuration, based on the schematic diagram provided above.

1. Pre-Treatment

Prepares feed water by removing particles, chlorine, and hardness that could damage RO membranes.

Component	Purpose
Sediment Filter/Activated Carbon/Softener	Conditions the city water for membrane treatment

2. RO-EDI Skid

The core purification unit. Reverse Osmosis (RO) removes up to 99% of dissolved solids and bacteria. Electrodeionization (EDI) further polishes the water to achieve ultrapure quality.

Technology	Function
RO	Removes salts, microbes, endotoxins
EDI	Ensures ultra-low conductivity

3. Sterile Distribution Loop

A hygienic, closed-loop system circulates purified water to all dialysis stations, minimizing contamination. Made from high-grade materials like PVDF or stainless steel to maintain sterility and resist biofilm buildup.

4. Hemodialysis Machine Area

Each machine receives sterile water for dialysate preparation. Water quality must meet the most stringent microbiological and endotoxin limits.

Why Choose Transform Water for Your Dialysis Water Treatment System?

Transform Water specializes in advanced, fully compliant water treatment systems tailored for hemodialysis applications. Here’s why healthcare providers trust us:

ISO 23500 & AAMI Compliant Designs
Custom-Built RO-EDI Systems with Ultrapure Output
High-Quality Components for Longevity and Sterility
Compact, Space-Efficient Layouts
Reliable Technical Support & Preventive Maintenance
Proven Installations in Accredited Dialysis Centers

Choosing Transform Water means investing in safety, reliability, and regulatory peace of mind—ensuring your facility meets the highest standards in patient care.

October 15, 2025 0 comment

Dialysis

Epidemiological Trends of Hemodialysis in the Philippines

by Rio Ocampo October 1, 2025

Photo from Verywell Health

Hemodialysis is a vital treatment for individuals with severe kidney conditions, particularly those with end-stage renal disease. In the Philippines, the number of people undergoing hemodialysis has steadily increased over the years. This trend reflects broader health, social, and economic factors influencing access to care and disease management. The following overview highlights key epidemiological trends and developments in hemodialysis across the country.

Chronic Kidney Disease (CKD) in the Philippines

Chronic kidney disease (CKD) affects 9.1% to 13.4% of the global population, with a significantly higher prevalence of 35.94% in the Philippines, impacting around 7 million people as of 2021. In the country, 94% of end-stage renal disease (ESRD) treatment is through hemodialysis, while peritoneal dialysis and kidney transplants make up just 4% and 2%, respectively. Dialysis patients increased by 42% from 2022 to 2023, driven by rising diabetes and hypertension rates.

Given that the number of dialysis patients has risen significantly, and considering the dominance of hemodialysis in treatment modalities, it’s reasonable to estimate that a substantial majority of the 35,714 dialysis patients are undergoing hemodialysis.

The Philippine Renal Disease Registry (PRDR) provides insights into the regional distribution of CKD patients undergoing hemodialysis between September 2022 and July 20, 2023:

A study focusing on CKD Stage 5 patients on hemodialysis with anemia admitted at Bicol Medical Center revealed the following demographic characteristics:

Age: Median age was 52 years, with a range from 19 to 85 years.

Gender: Majority were male, accounting for 67% of the patients.

Problems Facing Dialysis Centers in the Philippines

Dialysis centers in the Philippines face major challenges including:

Water Supply Interruptions – Hemodialysis needs large volumes of purified water. Crises like the 2019 Metro Manila water shortage disrupted treatments and forced hospitals to ration water or switch to peritoneal dialysis.
Water Quality Issues – Contaminated water can cause serious infections. Outbreaks like the 2021 Ralstonia case in Baguio and high bacterial counts in regional studies show persistent sanitation problems.
Regulatory Compliance – Despite DOH regulations requiring regular water testing and licensed maintenance, not all centers consistently meet these standards, especially in rural areas.

Is Your Dialysis Center’s Water System Safe, Compliant, and Reliable?

Hemodialysis requires ultra-pure water to ensure patient safety and equipment longevity. Any compromise in water quality can lead to serious health risks and costly operational downtime.

Whether you’re starting a new facility or upgrading an existing one, we provide specialized water treatment solutions tailored to dialysis centers. Our systems are built to meet DOH standards and ensure uninterrupted, safe treatment—even during supply disruptions.

Ready to take the next step? Fill out our contact form and let our experts guide you toward a safer, more reliable water solution for your dialysis operations.

October 1, 2025 0 comment

Dialysis

Philippine Guidelines and Compliance Requirements for Water Treatment in Hemodialysis Facilities

by David July 30, 2025

Photo from Perpetual Help Medical Center

Providing safe and effective hemodialysis treatment goes beyond the dialysis machine itself—it starts with water. The quality of dialysis water directly affects patient health outcomes, as patients are exposed to 120–200 liters of treated water per session and in the Philippines, the Department of Health (DOH) has established clear guidelines to ensure this vital element is consistently safe.

One system gaining attention for exceeding these standards is the AAMI Hi-Flow UF-type water treatment system, a concept supported by AAMI and ISO guidelines as early as 2014 and adopted in recent dialysis water system designs worldwide.

Overview of DOH Guidelines on Dialysis Water Treatment

Photo from The Ruth Foundation

The DOH mandates specific processes and monitoring protocols through its administrative orders:

🔹 AO 2012-0001

Outlines the licensure requirements for dialysis facilities, including:

A complete water treatment line: pre-treatment, reverse osmosis (RO), and post-treatment.
Compliance with AAMI or equivalent water quality standards.

🔹 AO 2013-0003

Focuses on:

Regular testing of water (chemical monthly; microbial weekly).
Use of Ultrafiltration (UF) post-RO for microbial and endotoxin control.
Establishing a Water Quality Management Program within the facility.

International Benchmark: ISO 23500 & AAMI Standards

The ISO 23500 Series (aligned with AAMI RD52/RD62 and updated with the AAMI TIR 34:2014 on High-Flow Water Systems) provides globally recognized parameters for dialysis water quality:

Parameter	Standard Dialysis Water	Ultrapure Dialysis Water
Bacteria (CFU/mL)	< 100	< 0.1
Endotoxin (EU/mL)	< 0.25	< 0.03
Heavy Metals (e.g., Al)	< 0.01 mg/L	Same

The AAMI TIR 34:2014 and updates to the ISO 23500-5:2019 standard recommend Ultrafiltration (UF) membranes as a post-RO solution to meet ultrapure water targets—especially important for facilities using online hemodiafiltration (HDF).

AAMI Hi-Flow UF-Type System: Features & Compliance

The AAMI Hi-Flow UF-Type System, introduced into widespread practice following the 2014 AAMI guidance, is designed to produce ultrapure dialysis water by incorporating Ultrafiltration membranes after the RO stage. Key highlights include:

✅ Bacterial and endotoxin removal to levels well within ISO 23500:2019 requirements.
✅ High-flow output suitable for multiple dialysis stations.
✅ UF membranes with pore sizes <0.01 µm as a final barrier before the dialysis machine.

Requirement	DOH/ISO Standard	AAMI Hi-Flow UF System (since 2014)	Compliant?
Reverse Osmosis Treatment	Required	Included	✅ Yes
Post-Treatment (UF)	Required for ultrapure water	Included	✅ Yes
Bacteria < 0.1 CFU/mL	Required for ultrapure water	Achieved	✅ Yes
Endotoxin < 0.03 EU/mL	Required for ultrapure water	Achieved	✅ Yes
Routine Testing Capability	Monthly (chem), Weekly (micro)	Compatible with inline monitoring	✅ Yes

Is Your Dialysis Center’s Water System Safe, Compliant, and Reliable?

Hemodialysis requires ultra-pure water to ensure patient safety and equipment longevity. Any compromise in water quality can lead to serious health risks and costly operational downtime.

Whether you’re starting a new facility or upgrading an existing one, we provide specialized water treatment solutions tailored to dialysis centers. Our systems are built to meet DOH standards and ensure uninterrupted, safe treatment—even during supply disruptions.

Ready to take the next step? Fill out our contact form and let our experts guide you toward a safer, more reliable water solution for your dialysis operations.

July 30, 2025 0 comment

Medical

Water for Reprocessing Endoscope Devices

by David July 1, 2025

Endoscope Reprocessing & Handling:

Endoscope Reprocessing is a multi-step, highly complex activity which includes pre-cleaning, leak testing, manual cleaning, rinsing after cleaning, visual inspection, high level disinfection (HLD), rinse after HLD, drying, storage and documentation.

Endoscope is usually reprocess in the Endoscope Washer Disinfector (EWD)

Water is used in the Endoscopy Unit for Endoscope Reprocessing:

a) Initial rinse-water;

b) Intermediate rinse-water

(not a critical factor if disinfectant and cleaning agents are compatible);

c) Final rinse-water

d) Diluent for chemicals.

Water Hardness

Water hardness Hard water (>200 mg/L CaCO3 equivalent) used in final rinse in the AER cycle may cause deposits on the endoscope.

These deposits will act as potential focus for soiling and recontamination of the endoscope.
It may also seriously impair the optical system of the endoscope.

Temperature

Endoscopes are unable to tolerate temperatures of 60°C or above, they cannot therefore be thermally disinfected and sterilised.
Instead, endoscopes are cleaned and sterilised using a chemical disinfection procedure and then rinsed in purified water (Final rinse water) to remove all traces of the disinfectant.
Water at too high temperature during the initial flushing stage may lead to the coagulation of proteins and may “fix” proteinaceous soil to the surface in parts of the endoscope.
Refer to manufacturer’s Instruction for Use (IFU) on optimal temperature setting required for the detergent and disinfectant used.

Microbial contamination

Water supply to AER should be treated using filtration, deionisation, or reverse osmosis (RO).
A 0.2µm filter is adequate to remove common microbial pathogens.
Deionised water may become contaminated with microorganisms and the resin column colonised with bacteria; hence it should be further decontaminated (i.e. either by heating or filtration etc) if used for final rinse of products intended for invasive use.
RO is performed under pressure through a semi-permeable membrane against an osmotic gradient.
The process will also remove a high proportion of organic material, bacterial endotoxins, and microorganisms.
RO units are fitted with a final endotoxin filter to control bacterial numbers are recommended.

Use of Water Softeners

Water softeners, or base-exchange softeners, consist of an ion-exchange column containing a strong cation resin in the form of Sodium Chloride.
Calcium and magnesium ions in the water are replaced by sodium ions.
The remaining sodium salts do not, like calcium salts, form hard deposits to foul heat exchangers or spray nozzles.
But if used as the final rinse they will leave white deposits on the load items as they dry.
The process is simple to operate with an automated in-line system, it will handle water with varying levels of hardness, and is simple and safe to regenerate.
The down sides are that after regeneration high levels of chloride ions might be present in the initial output from the softener, which should be run to waste.
Base-exchange softeners can cause a significant increase in the microbial content of the water, which should be taken into account when establishing the operational parameters of the microbial water treatment systems.

Recommendations:

Regular microbiological sampling of the rinse water is required to determine the risk References for Pseudomonas aeruginosa and atypical Mycobacterium species contamination.
Water used for cleaning and disinfection should be treated using filtration, reverse osmosis (RO) & deionization,
An endotoxin filter is required to remove common microbial pathogens at the downstream of the system.

References:

THE NATIONAL INFECTION PREVENTION & CONTROL GUIDELINES FOR ENDOSCOPY CENTRES 2023 (MOH)

Quality of the final rinse water for endoscope washer disinfectors A literature review
Adrie de Bruijn, Arjan van Drongelen

Recommendations and guidelines for endoscope reprocessing: Current position statement of digestive endoscopic society of Taiwan

Illustrations from: https://www.istockphoto.com/

Ready to Transform Your Water?

July 1, 2025 0 comment

Medical

Why Clean Steam for CSSD?

by David June 10, 2025

5 min read

Different Types of Steam Generation

Pure Steam – Pharmaceuticals and biotechnology; injectable drug production. Uses water for injection (WFI).

Clean Steam – Healthcare facilities, laboratories, food & beverage. Uses RO/DI water.

Plant Steam – Healthcare facilities, laundries, food & beverage, pulp & paper, petrochemical.

Uses softened/treated potable water.

How does Water Quality affect Steam Sterilization?

Water known as “the universal solvent” due to its ability dissolve more ions and substances compared to any other solution.

Often tap water is found to contain impurities, trace minerals and other contaminants such as metals, salts, and organic molecules derived from the environment or the water delivery system.

ELEMENTS OF CONCERN IN POTABLE WATER	EFFECT ON INSTRUMENTATION	WATER TREATMENT OPTIONS
Presence of metals (Aluminium, copper, iron, rust etc.)	Instrument staining, chamber discoloration Harbour bacterial growth	Addition of inline filters and reverse osmosis (RO) treatment system
Hardness (presence of calcium and magnesium)	Scale formation from mineral deposits	Addition of softeners in feed water
pH / alkalinity (presence of carbonate, hydroxide, and bicarbonate)	Instrument pitting, staining, and corrosion	Chemical dosing

What is Critical Water ?

Membrane separation process for purifying water.
Water is de-ionized.
Purifies water by removing containments, salts and other impurities.

Advantages: Removes dissolved inorganic solutes, bacteria and bacterial endotoxins

Safe to use for final rinse and steam generation

What is Softened Water ?

Calcium, magnesium is removed.

Advantages: Prevents scale built up and deposits.

What is Facility/Utility Water ?

Advantages: For initial flushing, washing, rinsing instruments

How is Clean Steam Made?

Electric heating elements can power clean steam generators, or they can use house steam to heat RO/DI water in a heat exchanger indirectly via heat exchangers.

This type of generator is also known as a steam-to-steam generator.

This process ensures the generated steam is free from additives and impurities that could compromise sterility.

Electric clean steam generators can be integrated within the sterilizer framework to minimize footprint requirements or be standalone generators.

Ready to Transform Your Water?

If you’re looking to elevate your facility’s water standards, you’ve come to the right place.

To protect the sensitive medical devices that require frequent cleaning and sterilization, hospitals must install water treatment systems designed to treat municipal water supplied to the sterile processing systems (e.g., steam sterilizers, ultrasonic cleaners, washers, sinks etc.)

Let us help you achieve industry compliance while enhancing operational efficiency.

Simply fill out our contact form, and one of our specialists will guide you through the process of transforming your water quality.

June 10, 2025 0 comment

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