Impact of Water Outages and Restrictions on Healthcare Facilities

Presented by:Jeremy Jernigan

Emergency Management CoordinatorColumbus Regional Healthcare System & Columbus County Health Department

Impacts to healthcare facilities Causes of restrictions/outages Actions to take Lessons learned Planning documents and guides

Overview

◦Hand hygiene◦Drinking water◦ Ice machines◦ Food preparation◦Bathing patients◦ Flushing toilets◦ Laundry◦Cleaning and sterilization

of instruments◦Dialysis◦ Fire suppression

◦Medical gas systems◦HVAC systems◦Decontamination/Hazmat

response◦Eyewash

Examples of water usage:

Hospitals Nursing homes Assisted living facilities Dialysis clinics Dental offices Doctors offices Group homes Home health ???

What types of facilites?

Causes of water supply interruptions

Natural disasters Fires Explosions Construction (on-site &

off-site) Vehicle accidents Failure related to the

utility providers infrastructure

Failure related to the facilities infrastructure

Diversion Evacuation Cancellation 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 notices

Fecal 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 notices

It’s not if it will happen but when it happens

Consumption◦Discontinue use of tap water for consumption

Turn of ice machines Soda fountains Label water fountains and sinks “Do not drink” Any other uses that would result in consumption

If only a “Boil Water Advisory” water can be boiled for consumption

Actions

Dishwashing◦ If a dishwasher does not reach 180 degrees then

disposable eating and drinking utensils should only be used

Actions

Food preparation◦During a boil water advisory

All food cooked to 165 degrees All food service workers use hand sanitizers after washing

hands◦Boil water notice or do not use

Use only prepackaged foods

Actions

Hand washing◦ Food service workers use hand sanitizers◦Healthcare 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.

Actions

Bathing◦Avoid 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

Actions

Columbus Regional Healthcare System – Boil Water Event – May 2012◦Plans were in multiple places and were at differing

stages◦City quickly notified the hospital but notifications to the

municipality in general were slow and inadequate◦Hospital 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 EM

Lessons learned

New Hanover Regional Medical Center – Water Main Break - July 2010◦Breakdown of communications internally – human error◦Reference documents were out of date◦Better communications with other facilities◦Communicated with local EM

Lessons Learned

Mission Hospital, Memorial and St. Joesph Campus– Water Main Break – May 2008 ◦Quickly moved bottled water to both sites◦Coordinated with FD to deliver non-potable water to

facilities for laundry, HVAC, toilet flushing◦Order Port-A-Johns for staff and visitors◦Delivered “Bath in a Bag” supplies to the facilities◦Communicated with local EM◦Activated their PIO within the ICS structure to

communicate internally and externally

Lessons Learned

NC 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 documents

HICS Planning Scenario 10 – Loss of Water

CDC Emergency Water Planning Guide for Hospitals and Healthcare Facilities

California Hospital Association - Hospital Water Disruption Best Practices

Planning documents

EPA – Planning for an Emergency Drinking Water Supply

Planning documents

Center for Medicare & Medicaid Services (CMS) 42 CFR 482.41

The Joint Commission 2009 Emergency Management Standards, specifically EM.02.02.09

Regulations related to planning

Impacts to healthcare facilities Causes of restrictions/outages Actions to take Lessons learned Planning documents and guides

Review

Mark Bennett – NHRMC Ned Fowler – Mission Health System

Thanks to:

Jeremy Jernigan(O) 910-640-4649(C) 910-398-0223

jjernigan@crhealthcare.org

Questions?