What Water is this Water? Huh?

As a health care professional, or a patient needing therapy, choosing which type of water to use for medical purposes may at times seem like a kid trying to choose between a PlayStation and an X-Box.

First thing’s first : WHAT IS THIS WATER ? 

 

Purified Water :  

• Water, usually produced using Groundwater or Tap water, then filtered or processed to remove impurities and contaminants, including : chemicals,                                                             micro-organisms (microbes, fungi…),                                                           metals (copper, load…). 
  
  
  

• In most Western countries, Public Drinking Water is purified to make it safe for human consumption. 
• It is produced in a range of purities, as standards for drinking water around the world vary. 

 

Mineral Water : 

• Is a Purified Water produced using water from a Mineral Spring that contains various minerals, such as salts and sulfur compounds. Mineral water may usually be still or sparkling according to the presence or absence of added gases. 

 

 

Distilled Water : 

• Is a Type of Purified Water taken to the extreme end of purity. 
• Common use for distilled water is in batteries and CPAP humidifiers
• Distillation involves boiling water and collecting the steam, which returns to water upon cooling. 
  
• It is usually considered sterile, depending on the collection of the steam and water. 
  
  
• Distilled water is made to get you as close to pure H2O as possible : no minerals, no chemicals, no microorganisms, no impurities. 
• It is Hypotonic with an                                                                                  Osmolarity of zero mOsmol/L 
• While distilled water is the purest type of water, it’s not necessarily the healthiest for everyone : 

 

Distillation typically removes around 99.9% of all minerals found in tap water. 

It is true that tap water is not a major source of mineral intake for most people, and drinking distilled water should be relatively safe, ONLY as long as a well-balanced diet is followed. 

In fact, exclusive distilled water drinking habits can be associated with : nausea, headache, vertigo, increased risk of fracture, preterm birth, heart disease ,loss of memory, dementia and Coma. 

 

Sterile Water: 

• Is a quality of Purified Water or Distilled Water that contains NO viable (able to reproduce) microorganism, such as fungi, spores, or bacteria. 
• Homemade Sterile Water made by boiling the water in a pot for 20 minutes or more will kill most pathogen microorganisms; it would however not be classified as Sterile Water for Medical Purposes. 
  
  
  

• Sterile Water belongs to a class of drugs called Sterile Irrigating Solutions. 
• Contains water that is sterilized and packaged for use as an irrigant. 
• By respecting certain criteria during manufacturing process, it can be adapted for injection 
• No antimicrobial agent or other                                                                      substance has been added. 
• “In use” time, after first entry, is 4-6h in ISO 5 environment at room temperature 

 

Sterile Water for Irrigation, USP  

• Is a sterile, distilled, nonpyrogenic water intended only for sterile irrigation, washing, rinsing and dilution purposes. It does not pass the same UPS regulation standards as SW for injection  

NOT SAFE FOR INJECTION 

 

 

 

Sterile Water for Injection, USP  

• Is a sterile, distilled, nonpyrogenic water intended for injection,  
• It is chemically designated H2O. pH 5.0 to 7.0. 
• It contains no bacteriostat, antimicrobial agent or added buffer,  
• It is supplied only in single-dose containers 

• Used for : dilute (concentrated solutes) or dissolve (powdered drugs) for injection. 

NOT safe for injection without a solute (may result in hemolysis). 

 

Bacteriostatic water for injection, UPS 

• Is a sterile, distilled, hypotonic, nonpyrogenic water intended for injection, that contains a Preservative with Bacteriostatic activity 

• Can be used multiple times up to 28 days once opened, 
• It should be stored in a dark place at temperatures between 15 to 25 degrees Celsius 
• Depending on multiple factors (including concentration, pH, temperature), the preservative used can : 
• Inhibit growth of newly contaminating microorganisms (Bacteriostatic) 
• OR destruct existing microorganisms (Antimicrobial) 

• Most antimicrobial are used in Sterile Water for their Bacteriostatic properties 
• Many preservatives with Bacteriostatic activity can be used  
• Most common Antibacterial preservative for injection is Benzyl alcohol 
• Most commonly used Antifungal preservative is a combination of Methylparaben and propylparaben 
• The key criteria for antimicrobial preservative selection are the preservative's dose, antimicrobial functionality, and “effect on the active ingredient”. 

That means, it may be NOT adapted to the product or solute you are intending to use it with (Please check before use : Medicinal leaflet , Doctor, Pharmacist, Medical Supplier) 

• NOT adapted for injection intrathecal, epidural, or for Neonates 
• NOT for irrigation 
• Some preservatives (Benzalkonium chloride) are gastrointestinal irritant , NOT adapted for Drinking. 
• Possible risk of allergy. 

• Used for : Diluting and Dissolving drugs or Flushing intravascular catheters.  

 

Sterile Saline for Injection 0,9%   

• Is a sterile, distilled, nonpyrogenic water intended for injection, that contains 9 grams of NaCl salt for each 100 ml of Sterile Water for injection. 
• Meant to be isotonic to human Blood (ready for injection) 

 

Other Sterile water preparations for injection: 

• Depending on pH, osmolarity, the chemical or mineral used, the resulting product can be ready for injection, suited for injection (used to dilute or dissolve several drugs). 
• However, you must seek professional advice as there are risks of : Infusion site reaction, vein thrombosis, deactivation or precipitation of drugs, and creation of toxic or pro-allergic (causing allergic reaction) components 

 

Some Norms and standards: 

USP: United States Pharmacopeial Convention 

ISO: International Standards Organization 

ISO 5 environment: Super clean (few over 0,5 microns particles per square foot) 

Hyper Filtered: (Unidirectional HEPA filtered Air Changes of 240-360 / H) 

HEPA: High Efficiency Particulate Air (Filter) as per US government regulations 

 

In conclusion: 

• Sterile water is simple for use and adapted for most, but the container should best be discarded after only one use 

• Bacteriostatic Water sure will have you think if it is adapted for you, but it can be stored and used multiple times, up to 28 days. 

• Purified, Sterile for Irrigation or Sterile for Injection depends on your intended use : on equipment, on your body or into your body, then on your required level of purity 

If you are looking for:

     Cost effective

     Multiple use

     Easy to use

     Sterile solution

     Adapted for diluting or dissolving drugs and solutes 

     Injection (intravenous, Intramuscular, Subcutaneous,                                      Intradermic) 

     You are looking for a : Clean solute to use for diluting or dissolving              drugs 

 

Then you must consider: Bacteriostatic Sterile Water, UPS for injection 

 

If you are looking for:

 For external use, cleaning wounds, irrigation  

 Preparing for oral nutrition or drinks,  

 Cleaning and preserving equipment (such as contact lenses, denture           or humidifiers) from bacterial growth

Then, depending on the level of purity you need, you might consider           (in increasing level of purity)

Purified waters  - Mineral waters - Sterile Water for Irrigation - Distilled Water - Sterile Water for Irrigation UPS 

 

Lastly : What size should I get ? 

• That really depends on a simple equation :  

(Single vs Multiple use/time unit) x (volume you want for each use) = Your BEST Choice 

(5 ml, 10, 20, 30, 50, 100, 1000, 2000, 3000 ml) 

 

Disclaimer : 

This blog is for general education and does not intend to replace your professional advisor 

Please don’t buy from unprofessional sellers 

Please share your intended use with your Doctor, Pharmacist or Health Supplier 

 

By Dr. Omar, MD