Monitoramento e tratamento de água em serviço de diálise de unidade de tratamento intensivo localizada no município de Macapá/Brasil

Abstract

The state of Amapá has one of the most precarious indicators of basic sanitation among other Brazilian states, directly affecting the public health system. This study evaluates the treatment and monitoring of water quality in a compact and isolated water treatment plant (WTP) in a dialysis clinic, evaluating critical aspects of raw water collection, operational units and medicinal destination. This study provides basic support for management and decision-making regarding the risks inherent in water treatment processes, aiming at the safety and health of users. The objective of the research is to evaluate the physical-chemical and microbiological quality of water in the WTP in an intensive renal treatment clinic located in the city of Macapá/Amapá/Brazil. The study consisted of the following methodological steps: a)use of monthly series of water quality parameters made available by the clinic's monitoring sector, totaling ≈ 1100 individual analyses of different metal, physical-chemical and microbiological parameters provided for in the legislation; b) evaluation of the compliance and efficiency of the WTP treatment process. The post-osmosis (PO) and dialysis solution (DS) stages included the counting of heterotrophic bacteria, pathogen research, presence of endotoxins and metal content (Al, Hg, Se, etc.). The results indicated bacterial contamination in at least 2 monitoring points, with the presence of heterotrophic bacteria (HET). Metal concentrations above the limits established by law were found in only 1.14% of the samples collected for the Ca parameter, exceeding the legally permitted limits. Electrical conductivity showed non-compliance in 11.20% of the samples, followed by pH (13.02%), color (0.26%), total chlorine (4.95%) and turbidity (0.52%). However, no legal non-compliances were identified for the other parameters analyzed (Al, Sb, Ba, Be). All these parameters were compared with the legal limits of the National Health Surveillance Agency (ANVISA) RDC 11/2014, which regulates conventional hemodialysis services in Brazil. We conclude that the results demonstrate the importance of water quality monitoring as a basic instrument to support decision-making in the operational management of WTPs. In addition, it serves as a guarantee of patient health safety in critical water treatment processes. Thus, the evidence observed also exposes a minimal sanitary vulnerability of its current operation.