Int. J. Environ. Res. Public Health 2012, 9, 2758-2771; doi:10.3390/ijerph9082758 OPEN ACCESS International Journal of Environmental Research and Public Health ISSN 1660-4601 www.mdpi.com/journal/ijerph Article Microbiological Surveillance and State of the Art Technological Strategies for the Prevention of Dialysis Water Pollution Piergiorgio Bolasco 1,*, Antonio Contu 2, Patrizia Meloni 2, Dorio Vacca 2 and Andrea Galfrè 1 1 2 Territorial Department of Nephrology and Dialysis, ASL, Quartu Sant’Elena, Cagliari 09045, Italy; E-Mail: dialisi.territorio@asl8cagliari.it University Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, Cagliari 09121, Italy; E-Mails: acontu@unica.it (A.C.); lia@unica.it (P.M.); doriovacca@gmail.com (D.V.) * Author to whom correspondence should be addressed; E-Mail: pg.bolasco@tin.it; Tel.: +39-070-609-7332; Fax: +39-070-609-7340. Received: 1 June 2012; in revised form: 4 July 2012 / Accepted: 16 July 2012 / Published: 2 August 2012 Abstract: Methods: The present report attempts to illustrate the positive impact on the microbiological quality of dialysis patients over a 15-year period through the progressive implementation of state-of-the-art technological strategies and the optimization of microbiological surveillance procedures in five dialysis units in Sardinia. Results: Following on better microbiological, quality controls of dialysis water and improvement of procedures and equipment, a drastic improvement of microbiological water quality was observed in a total of 945 samples. The main aim was to introduce the use of microbiological culture methods as recommended by the most important guidelines. The microbiological results obtained have led to a progressive refining of controls and introduction of new materials and equipment, including two-stage osmosis and piping distribution rings featuring a greater capacity to prevent biofilm adhesion. The actions undertaken have resulted in unexpected quality improvements. Conclusions: Dialysis water should be viewed by the nephrologist as a medicinal product exerting a demonstrable positive impact on microinflammation in dialysis patients. A synergic effort between nephrologists and microbiologists undoubtedly constitutes the most effective means of preventing dialysis infections.