University of Wisconsin Hospital and Clinics
TITLE: Disinfection of the RO,
distribution loop, storage tank and
Hemodialysis machine inlet water line.
REVISED: October 1, 2016
Page 1 of 2
Nurse Manager: Joan Watson, MS, RN
Director: Ann Malec, DNP, RN, NEA-BC
Medical Director: Alex Yevzlin, MD
To prevent the growth of microorganisms and biofilm in the RO water
storage/distribution system and hemodialysis machine inlet water line.
A. The RO, distribution loop, storage tank, Fresenius and Gambro machine inlet water line
will be disinfected monthly using Minncare™ (Hydrogen Peroxide and Peracetic Acid
mixture) following the manufacture minimum recommended dwell times of 60 minutes.
III. GENERAL INFORMATION
A. Minncare® (Hydrogen Peroxide and Peracetic Acid mixture) is used during the
disinfection of the RO, distribution loop, storage tank, and Fresenius machine inlet water
line. It is stored in the tech room in original packaging inside a plastic non corrosive bin.
B. Minncare is diluted to 1% potency, is circulate throughout the system during the
procedure and at the conclusion of disinfection is disposed of in the sanitary sewer
C. See Material Safety Data Sheet for more detailed information on this cleaning solution.
Minncare solution Peracetic Acid 1% Potency Reagent Strips
Gloves and Safety Glasses Peracetic Acid Residual test strips
1. Verify that all patients are disconnected from the system.
2. Notify the night nurse that the water system is out of service until further notice.
3. Apply Do Not Use Signage to the tech room.
4. Disconnect all dialysis machines from the distribution loop.
5. Shut off the main RO system.
6. Drain the holding tank to 200 gallons.
7. Take the DI System off line and connect the hoses together.
8. Shut off both distribution pumps and the UV Light.
1. Pour two gallons of Minncare into the holding tank.
2. Turn on distribution pump 1 for five minutes then switch to running distribution
pump 2 for five minutes.
3. Verify that the disinfection solution is at 1% using potency reagent strips.
4. Rinse disinfection solution through all points of use and sample valves.
5. Rinse disinfection solution through all Fresenius Machines.
6. Start a 1 hour timer.
7. Alternate distribution pump 1 and 2 every 15 minutes.
8. Once the minimum one hour dwell time is complete turn off both distribution
9. Completely drain the holding tank.
1. Rinse the holding tank until clear of all Minncare.
2. For all components, verify negative residual (0 ppm) using Peracetic Acid
Residual test strips.
3. Fill the holding tank and begin to rinse the RO Loop.
4. Continue to rinse the RO Loop until Sample Valve # 10 (end of loop) test
negative for residual.
5. Rinse all points of use, sample valves and Fresenius Machines until each test for
D. Reconnect RO, UV and DI components of water purification system.
1. Connect the DI system back to the loop.
2. Verify both distribution pumps are set back to Auto.
3. Turn the UV Light system back on.
4. Perform final checks of being sure DI is back to 18 mega ohm.
5. Do final residual test for Minncare from Sample Valve # 10, end of loop.
A. Record the procedure as performed on the Dialysis Equipment Service Report and file the
report in the RO water maintenance book.
o Association for the Advancements of Medical Instrumentation (AAMI), Dialysate
for Hemodialysis, ANSI/AAMI RD52:2004.
o Association for the Advancements of Medical Instrumentation (AAMI), Water
Treatment Equipment for Hemodialysis Applications, ANSI/AAMI RD62:2006
o Centers for Medicare and Medicaid Services. Conditions for Coverage for End-
Stage Renal Disease Facilities Interpretive Guidance, 2008.