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International
Standard
ISO 23500-2
Second edition
Preparation and quality
2024-07
management of fluids for
haemodialysis and related
therapies —
Part 2:
Water treatment equipment for
haemodialysis applications and
related therapies
Préparation et management de la qualité des liquides
d’hémodialyse et de thérapies annexes —
Partie 2: Équipement de traitement de l’eau pour des applications
en hémodialyse et aux thérapies apparentées
Reference number
© ISO 2024
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Published in Switzerland
ii
Contents Page
Foreword .v
Introduction .vi
1 Scope . 1
2 Normative references . 1
3 Terms and definitions . 2
4 Requirements . 2
4.1 Dialysis water quality requirements .2
4.1.1 General .2
4.1.2 Chemical contaminant requirements .2
4.1.3 Organic carbon, pesticides and other chemicals .3
4.1.4 Microbiology of dialysis water .3
4.2 Water treatment equipment requirements .3
4.2.1 General .3
4.2.2 Backflow prevention .5
4.2.3 Tempering valves .5
4.2.4 Sediment filters .5
4.2.5 Cartridge filters .5
4.2.6 Softeners .5
4.2.7 Anion exchange resin tank .5
4.2.8 Carbon media .5
4.2.9 Chemical injection systems .7
4.2.10 Reverse osmosis .7
4.2.11 Deionization .8
4.2.12 Bacteria and endotoxin retentive filters .8
4.2.13 Storage and distribution of dialysis water .8
4.3 Electrical safety of water treatment equipment for haemodialysis applications and
related therapies .10
5 Testing. 10
5.1 C onformity with dialysis water quality requirements.10
5.1.1 General .10
5.1.2 Microbiology of dialysis water .11
5.1.3 Maximum level of chemical contaminants . 12
5.2 C onformity with water treatment equipment requirements . 12
5.2.1 General . 12
5.2.2 Backflow prevention . 13
5.2.3 Tempering valves . 13
5.2.4 Sediment filters . 13
5.2.5 Cartridge filters . 13
5.2.6 Softeners . 13
5.2.7 Anion exchange resin tanks . 13
5.2.8 Carbon media .14
5.2.9 Chemical injection systems .14
5.2.10 Reverse osmosis .14
5.2.11 Deionization .14
5.2.12 Endotoxin retentive filters .14
5.2.13 Storage and distribution of dialysis water .14
6 Labelling .15
6.1 General . 15
6.2 Device or system markings . 15
6.3 Product literature . 15
Annex A (informative) Rationale for the development and provisions of this document .18
Annex B (informative) Reference tables .29
iii
Bibliography .31
iv
Foreword
ISO (the International Organization for Standardization) is a worldwide federation of national standards
bodies (ISO member bodies). The work of preparing International Standards is normally carried out through
ISO technical committees. Each member body interested in a subject for which a technical committee
has been established has the right to be represented on that committee. International organizations,
governmental and non-governmental, in liaison with ISO, also take part in the work. ISO collaborates closely
with the International Electrotechnical Commission (IEC) on all matters of electrotechnical standardization.
The procedures used to develop this document and those intended for its further maintenance are described
in the ISO/IEC Directives, Part 1. In particular, the different approval criteria needed for the different types
of ISO document should be noted. This document was drafted in accordance with the editorial rules of the
ISO/IEC Directives, Part 2 (see www.iso.org/directives).
ISO draws attention to the possibility that the implementation of this document may involve the use of (a)
patent(s). ISO takes no position concerning the evidence, validity or applicability of any claimed patent
rights in respect thereof. As of the date of publication of this document, ISO had not received notice of (a)
patent(s) which may be required to implement this document. However, implementers are cautioned that
this may not represent the latest information, which may be obtained from the patent database available at
www.iso.org/patents. ISO shall not be held responsible for identifying any or all such patent rights.
Any trade name used in this document is information given for the convenience of users and does not
constitute an endorsement.
For an explanation of the voluntary nature of standards, the meaning of ISO specific terms and expressions
related to conformity assessment, as well as information about ISO's adherence to the World Trade
Organization (WTO) principles in the Technical Barriers to Trade (TBT), see www.iso.org/iso/foreword.html.
This document was prepared by Technical Committee ISO/TC 150, Implants for surgery, Subcommittee
SC 2, Cardiovascular implants and extracorporeal systems, in collaboration with the European Committee for
Standardization (CEN) Technical Committee CEN/TC 205, Non-active medical devices, in accordance with the
Agreement on technical cooperation between ISO and CEN (Vienna Agreement).
This second edition cancels and replaces the first edition (ISO 23500-2:2019), which has been technically
revised. The main changes are as follows:
— alternative water treatment technologies (e.g. reverse osmosis pre-treatment with ultrafiltration) have
been added;
— alternatives to classic microbial analytical methods [endotoxin testing using involving recombinant
Factor C (rFC)] have been added.
A list of all parts of the ISO 23500 series can be found on the ISO website.
Any feedback or questions on this document should be directed to the use
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