1. PB - Dialysis Review1 DIALYSIS MACHINES REVIEW OF PLUMBING INSTALLATION REQUIREMENTS

2. PB - Dialysis Review2 Dialysis Machine Review Background Cairns Regional Council Plumbing Inspectors were asked by the Queensland Health, Cairns, Building Engineering and Maintenance Services (BEMS), Plumbers to review the plumbing requirements for the installation of Dialysis Machines into private homes. This review was instigated due to a new type of machine, the new, NxStage, System One, now being installed in addition to the previous system. The new system is more portable allowing the Client to move more freely around the home and allows them to travel with minimal disruption, thus improving their quality of life.

3. PB - Dialysis Review3 OLDER STYLE OF MACHINE Requires permanent plumbing connections NEW MACHINE No permanent plumbing connections required

4. PB - Dialysis Review4 New machine in portable setup Allows for travel Dialysate mixture can be pre- ordered to arrive into the next town in travel itinerary (no dependency on water supply) Increased quality of life for client

5. PB - Dialysis Review5 Old Machine – Water & Wastewater Connection Twin Cartridge Filter Twin Carbon Filter Permanent connection to water supply Dual Check Valve required – AS 3500 Pt 1 – Table F1 Water supply must be on whilst treatment is in progress Machine makes up Dialysate during treatment. Waste is permanently connected via tundish – Sanitary Plumbing required Around 600 litres per treatment used

6. PB - Dialysis Review6 New Machine – Water Connection Integral Cartridge Filter supplied as part of unit – only filtration required Line strainer & Dual Check Valve supplied & fitted by BEMS Dual Check Valve required – AS 3500 Pt 1 – Table F1 Machine makes up Dialysate into 60 litre bags. Water supply is then disconnected. – machine now able to be moved around the house independent from water supply for 3 treatments

7. PB - Dialysis Review7 New Machine – Waste Connection The wastewater from these machines is clear, however, preferred point of discharge is not to waste fixtures. The waste is a low velocity pumped discharge. This trial the waste is discharged to a WC. No sanitary plumbing work required BEMS have devised an adaptor that discharges over the WC This method was adopted to suite all applications – Some clients look after the equipment better than others A non-return similar to a waterless trap is installed in case of surcharge of the pan (in lieu of an air gap) These machines only discharge 20 litres per treatment

8. PB - Dialysis Review8 New Machine – Waste Connection The new machines are cleaned manually by using a syringe. By using this method there is no risk of any backflow contamination of the water supply as there is no direct connection to the water supply. Queensland Health provide extensive training to their client prior to installation of the unit into the client’s home. This ensure that any health issues about infection etc are minimised.

9. PB - Dialysis Review9 All Machines – Water Quality Queensland Health test samples of the water supply from each individual dwellings prior to commissioning of the unit to ensure the water quality is suitable for dialysis treatment. If a client moves to a different premises, the water from the new dwelling is tested as above. This means that despite the entire new unit is reasonably easy to transport, Queensland Health does not condone connecting the unit to any water supply other than a trusted site. As previously mentioned, when the new units are used for travel, the Client arranges for pick up of the Dialysate mixture from Qld Health Centres along their travel route.

10. PB - Dialysis Review10 All Machines – Legislation – Australian Standards ISSUELEGISLATIONSECTIONCOMMENT Backflow PreventionAS/NZ 3500.1Table F1Dual Check Valve fitted Line StrainerAS/NZ 3500.112.3 (a)Line strainer fitted Water QualityAS/NZ 3500.112.2 – Note 1.Qld Health tests water supply to all new installs. Portable Units use Dialysate pre-prepared by Qld Health Utility Operator Notification AS/NZ 3500.112.2 – Note 2.Qld Health notifies Cairns Water Operations upon installation of all units There is no need to notify other Utility Operators when travelling with Portable Units as water supply is not required The risks involved with unplanned shut downs of the water supply is minimised with the new machines, as the Dialysate is pre-made for 3 treatments. Meter IdentificationAS/NZ 3500.112.5Qld Health Plumbers to spray meter Blue

11. PB - Dialysis Review11 All Machines – Legislation – Plumbing & Drainage Act ISSUELEGISLATIONSECTIONCOMMENT Water Supply & Sanitary Plumbing Installation P&D Act119All permanent connections to the water supply and sanitary plumbing & drainage must be performed by a licensed plumber. (Max penalty 165 Penalty Units - $16500) Approvals – Old Machines (new installs) P&D Act81Due to the extent of the permanent connections to the water supply and sewer, a Form 1 for Compliance Assessment of the work will be required Approvals – New type machines P&D ActVariousAs a control valve is the only plumbing work involved and is often teed off existing fixture service pipes and no connection required to the sanitary drain, it would be unreasonable to request a form 1 & fees. Due to the minor nature of the work, CRC will accept a Form 4. This will notify the Council of the work performed.

12. PB - Dialysis Review12 RECOMMENDATIONS All units to be supplied with a permanent connection to water supply with a control valve inline strainer and dual check valve. Wastes from the new installations of the Old Machines to discharge to a trapped tundish directly connected to drain or a stack (not to Floor Waste Gullies) Wastes from the New Machines to discharge over a WC Pan via the adaptor developed by BEMS. The performance of this adaptor is to be monitored by BEMS and any modifications to be assessed by the Plumbing Inspectors. Queensland Health continue to provide training for their clients on these machines prior to installation in their homes

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