Impact of Water Outages and Restrictions on Healthcare FacilitiesPresented by:Jeremy JerniganEmergency Management CoordinatorColumbus Regional Healthcare System & Columbus County Health DepartmentImpacts to healthcare facilitiesCauses of restrictions/outagesActions to takeLessons learnedPlanning documents and guides

OverviewHand hygieneDrinking waterIce machinesFood preparationBathing patientsFlushing toiletsLaundryCleaning and sterilization of instrumentsDialysisFire suppressionMedical gas systemsHVAC systemsDecontamination/Hazmat responseEyewashExamples of water usage:

HospitalsNursing homesAssisted living facilitiesDialysis clinicsDental officesDoctors officesGroup homesHome health???What types of facilites?Causes of water supply interruptionsNatural disastersFiresExplosionsConstruction (on-site & off-site)Vehicle accidentsFailure related to the utility providers infrastructureFailure related to the facilities infrastructure

DiversionEvacuationCancellation of services

Effects of water supply interruptions

System Pressure Events low or no pressure can cause back siphonage and introduce bacteria into drinking water.Coliform Boil Water Advisory total coliform bacteria has been detected in the drinking water system. This can indicate the presence of other harmful bacteria and until test results show no coliforms all water for consumption should be boiled.Drinking water advisories and noticesFecal Coliform Notice testing has indicated that fecal coliforms are present and the water may be contaminated with human or animal waste. All water for consumption should be boiled.Do Not Drink the Water Water has been contaminated and should not be used for consumption.Do Not Use the Water Water is contaminated and should not be used for consumption, bathing, cleaning, etc.Drinking water advisories and noticesIts not if it will happen but when it happensConsumptionDiscontinue use of tap water for consumptionTurn of ice machinesSoda fountainsLabel water fountains and sinks Do not drinkAny other uses that would result in consumptionIf only a Boil Water Advisory water can be boiled for consumptionActionsDishwashingIf a dishwasher does not reach 180 degrees then disposable eating and drinking utensils should only be used

ActionsFood preparationDuring a boil water advisoryAll food cooked to 165 degreesAll food service workers use hand sanitizers after washing handsBoil water notice or do not useUse only prepackaged foods

ActionsHand washingFood service workers use hand sanitizersHealthcare workers use alcohol-based antiseptic hand rubs***Do not use contaminated water to scrub for surgeries, waterless surgical scrubs should be used

***Workers caring for patients with C. Diff need to use soap and water for hand washing.ActionsBathingAvoid bathing anyone with weakened immune systems, elderly, and children. Use waterless bath products.Care should be taken to not get contaminated water into open wounds

ActionsColumbus Regional Healthcare System Boil Water Event May 2012Plans were in multiple places and were at differing stagesCity quickly notified the hospital but notifications to the municipality in general were slow and inadequateHospital made good use of signage to communicate to patients, staff, and visitors not to use the water for consumption.Hospital has only one water source and only one way for water to enter the building.Communicated with local EMLessons learnedNew Hanover Regional Medical Center Water Main Break - July 2010Breakdown of communications internally human errorReference documents were out of dateBetter communications with other facilitiesCommunicated with local EMLessons LearnedMission Hospital, Memorial and St. Joesph Campus Water Main Break May 2008 Quickly moved bottled water to both sitesCoordinated with FD to deliver non-potable water to facilities for laundry, HVAC, toilet flushingOrder Port-A-Johns for staff and visitorsDelivered Bath in a Bag supplies to the facilitiesCommunicated with local EMActivated their PIO within the ICS structure to communicate internally and externallyLessons LearnedNC Drinking Water Section Quick Reference Guide for Public Notification

Environmental Health Emergency Preparedness and Recovery Guidance Manual For North Carolina

CDC Healthcare Water System Repair Following Disruption of Water Supply

Planning documentsHICS Planning Scenario 10 Loss of Water

CDC Emergency Water Planning Guide for Hospitals and Healthcare Facilities

California Hospital Association - Hospital Water Disruption BestPractices

Planning documentsEPA Planning for an Emergency Drinking Water SupplyPlanning documentsCenter for Medicare & Medicaid Services (CMS) 42 CFR 482.41The Joint Commission 2009 Emergency Management Standards, specifically EM.02.02.09Regulations related to planningImpacts to healthcare facilitiesCauses of restrictions/outagesActions to takeLessons learnedPlanning documents and guides

ReviewMark Bennett NHRMCNed Fowler Mission Health System

Thanks to:Jeremy Jernigan(O) 910-640-4649(C) 910-398-0223jjernigan@crhealthcare.orgQuestions?