INDONESIA TECHNICAL EVALUATION

REPORT
21ST November 2005

MEDICAL EQUIPMENT

For the rehabilitation of Zainoel Abidin Hospital,

Banda Ache
Technical Evaluation Report For Reverse Osmosis
Water Treatment Plant For Haemodialysis
Department

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Table Of Content

1. INTRODUCTION………………………………………….……………………………1
1.1 BACK GROUND………………………………………………………….1
2. CURRENT SITUATION ……………………………………………….………………….1
2.1 DESIGN…………………………………………………..…………………….1
2.2 INSTALLATION…………………………………………..…………………….1
2.3 MAINTENANCE…………………………………………………….…………2
3. RECOMMENDATION…………………………………………………..………………2
3.1 DESIGN………………………………………………………….……………..2
3.2 MAINTENANCE ………………………………………………………………3
4. CONCLUSION……………………………………………………..……………………3

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1. INTRODUCTION
1.1. BACKGROUND

At this moment there is only one Reverse Osmosis Water Treatment Plant located in Haemodialysis
department of Rumah Sakit Umum Sultan Zainoel Abidin, Banda Aceh. Japanese Government donated the
system. Five units of haemodialysis machine, Central Sterilization & Storage Department, Laboratory
Department and other Department use the output from the system. The installation was not done properly.
At this moment the Haemodialysis department provides treatment to 15 patients per day. The department
operates in three shifts, 6 days per week. Each patient requires at least 120L of reverse osmosis water for a 4-
hours treatment, which is taking place every three days. In addition the hospital is planning to provide
treatment for at least 21 patients per day.

2. CURRENT SITUATION
2.1. DESIGN
Base on diagram as per annex 1: -

 The current RO System is design with a sufficient capacity for 10 haemodialysis machine including
artificial kidney washing.
 One main system without backup system.
 Silica Filter or equivalent was not installed in pre-treatment section.
 No proper backwash system. Backwash facilities not available for carbon column and not properly
installed for softener column.
 Reverse Osmosis Output piping is not in close-loop.
 In case of main water supply failure the total water storage is sufficient for four hours operation (one
treatment) of ten unit of haemodialysis machine,.
 Sufficient outlets for water sample taking.
 Insufficient alarm or safety device.

2.2. INSTALLATION
There two critical issues observed:

 No proper arrangement of Reverse Osmosis Water component due to limitation of room size.
Reverse Osmosis Storage tank with accessories and UV Light installation should be located in
Reverse Osmosis Water Treatment Plant Room instead of in Reuse Room. Existing room size is
only 3x3 meters.
 Clinical waste water from artificial cleaning and haemodialysis machine are not properly connected
to sewerage treatment plant or septic tank.

2.3. MAINTENANCE

Maintenance was not being carried out properly to the system. Finding during visit were as follow: -

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  Brine tank was empty and seem not being operated for quite some time due no supply of chemical
(NACL).
 No backwash on Carbon Column.
 Backwash for softener filter was not installed properly.
 Plant room area dirty- spillage of used lubrication was not cleaned properly.
 Water flow meter for water rejection malfunction and dirty.
 Leakages found in several connections.
 Water quality was not checked.

3. RECOMMENDATION
3.1. DESIGN
Proposal of design as per Annex 2.

 Reverse Osmosis Backup system is required. Capacity should be sufficient at least for 8 units of
haemodialysis machine.
 Reverse Osmosis Plant room to resize. The area should be at least sufficient to cater Reverse Osmosis
System (main and back-up), RO Storage Tank and Deionise Water tank. Dedicated raw water tank can
be located to the nearest area.
 Silica, Carbon and Softener should come with dedicated automatic back wash system in order to
lengthen the filter life span.
 Pre-treatment portion should consist of Silica, Carbon and softener Filter. Failure to comply may
jeopardise the water quality.
 Material for piping, connection and storage should be food grade stainless steel, ABS or better.
 RO output piping should in close loop with appropriate size of UV light and appropriate speed of
continuous water circulation. The purpose is to minimise algae and bacteria growth. This also applies to
artificial kidney washing piping.
 RO water storage tank should be located as near as possible to Filtration system.
 Sufficient failure alarm or automatic device should be made available. This is very important to ensure
there is no disruption due to electrical supply, water supply or component failure.
 Auto sequencer should be provided to ensure the backup system is not in ideal situation (not operation)
all the time.

3.2. MAINTENANCE
Comprehensive maintenance should consist of:

 Daily Inspection
Item to check

 System functionality – should be no failure to component, connection

 Perform backwash to all filtration column (if necessary).
 Output water Quality –check water conductivity should comply AMMI standard.
 All data should be recorded in the “Inspection log sheet” which is attached to the machine.

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  Preventive Maintenance
Recommended every 3 monthly.
Item to check

 System functionality – Should no failure to all component.

 Check for indicator accuracy.
 Replace and Install wear and tear component/item.
 Water Quality- send RO water sample for Laboratory Test. The water quality should comply with
AMMI standard (water quality standard).
 Proper Preventive Maintenance Checklist should be used to record the activities.

4. CONCLUSION

Base on the demand on dialysis treatment and the condition of existing system, Haemodialysis Department
should have a reliable, sufficient capacity and comply with standard. The new system should consider the
item as per stated in the recommendation.

Prepared By:

Samsudin Asngad

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