Objective To investigate the management and maintenance status of dialysis water treatment system in hemodialysis center of hospitals in a province, analyze the relationship between the relevant factors such as reverse osmosis membrane, pipeline disinfection and the total bacterial colony count and endotoxin level detected in dialysis water, identify risk factors and explore improvement measures. Methods Dialysis water from outlet of reverse osmosis unit and backwater inlet of water pipeline in 18 hospitals was collected and enriched by membrane filtration method,specimens were cultured on tryptone glucose extract agar (TGEA) for 168 hours at 20℃, bacterial colony counting were conducted and endotoxin of parallel water specimens was detected. Questionnaire was designed to investigate the management and maintenance information of dialysis water system. Results The interval length between sampling time and reverse osmosis film replacement was positively correlated with the total number of bacterial colonies at the backwater inlet, as well as endotoxin at backwater inlet and outlet of reverse osmosis unit. Interval length between sampling time and the last time pipeline disinfection was negatively correlated with endoto-xin at backward inlet and outlet of reverse osmosis unit, allocation of professional engineers was negatively correlated with the total number of bacterial colonies at backwater inlet and endotoxin at outlet, while the length of the hose was positively correlated with endotoxin at backwater inlet. Regression analysis showed that the duration of using, the number of dialyzers and the number of dialysis patients also affected the microbial indicators of dialysis water. Conclusion Maintenance and replacement of reverse osmosis membrane, disinfection of water pipeline, allocation of professional engineers, scale of dialysis center and length of pipeline are the main influencing factors of microbial indicators of dialysis water. There are differences in the management and maintenance of water treatment system in different hospitals, so it should be promoted by quality control to achieve homogeneity.