The Interface between Water and the Operating Room · 2. Water Use Control . 1. IMPACT ANALYSIS 2....

9/15/2014

1

The Interface between Water and the

Operating Room Key Water Safety and Sustainability Opportunities

© 2014 Practice Greenhealth

9/15/2014

2

Bias Disclosure Phigenics does not sell chemicals or disinfection devices.

We have no commercial affiliation with suppliers or manufacturers of such

products. We do not accept money from suppliers or manufacturers to

evaluate their products.

Phigenics is paid to provide commercially independent expert guidance for

development and implementation of water management programs. The

purposes are to prevent building-associated injury and disease and to

improve operational efficiency of facilities.

We provide independent validation and verification through real-time

monitoring of control measures, on-line data management, environmental

testing for all waterborne pathogens and analytical services for water

chemistry.


9/15/2014

3

Biographies

Melissa Cain Midwest Regional Manager | Principal

Phigenics, LLC

Education: B.S. Biochemistry & Molecular Biology University of Wisconsin-Madison

Experience: -Healthcare Industry Prior to Phigenics

(Abbott Diagnostics) -Joined Phigenics in January 2006 -Facilitates Water Management Programs in WI & IL


9/15/2014

4

Biographies

Kellen Utecht Director of Sustainability

Phigenics, LLC

Education: MBA – University of Arkansas MPS – Clinton School of Public Service BBA – Economics Experience: -WWF-Turkey Water Stewardship -The Sustainability Consortium -Joined Phigenics in January 2014


9/15/2014

5

What is Healthcare Water Sustainability?

• Economic Benefits: Water and Sewer, Energy, Chemical, and Workforce Savings

• Environmental Benefits: Water, Waste, and Carbon Reduction and Ecosystem Protection

• Social Benefits: Worker and Patient Health and Safety, Regulatory Compliance and Improved Cross-Department Communication

The Delicate Balance Between Safety and Conservation!


9/15/2014

6

What is Healthcare Water Sustainability? The Delicate Balance Between Safety and Conservation!


9/15/2014

7

Healthcare Water Interface Stakeholders


9/15/2014

8

Hazard

Analysis

Hazard Control

Validation &

VerificationHACCP

Water Safety

Plan

What is the hazard?

How do we

prevent the hazard

from harming

people?

How do we know

the hazard has

been prevented

from harming

people?

How/where does water impact the OR?

Impact

Analysis

How do we optimize water use to ensure

successful OR procedures?

Water Use Control

Validation &

Verification

How do we know water use

has been optimized?

OR Water Management Framework


9/15/2014

9

Impact Analysis: How/Where?


9/15/2014

10

OR-Water Impact Analysis: How/Where?

2. Sterile Processing • Cleaning/Rinsing • Steam Sterilization

1. Direct Potable Water Exposure Points • Scrub Sinks • Post-Operative Water Usage

3. OR Comfort Cooling • HVAC Service, significant water usage • Patient Safety • Surgery Team Comfort


9/15/2014

11

OR-Water Impact Analysis

1. IMPACT ANALYSIS

How/Where Potential Impacts

Water quality and safety for potable water

• Potential for HAI’s associated with water system • Opportunities to conserve water while ensuring safe conditions

Sterile processing • Asset Loss: Damage to surgical instruments • Opportunities to optimize efficiency of steam generation processes

HVAC/comfort cooling

• Opportunities to optimize efficiency of water & energy usage to provide cooling to OR

• Optimize Cooling tower water safety for facility and community


9/15/2014

12

Hazard

Analysis

Hazard Control

Validation &

VerificationHACCP

Water Safety

Plan

What is the hazard?

How do we

prevent the hazard

from harming

people?

How do we know

the hazard has

been prevented

from harming

people?


Impact

Analysis



Water Use Control

Validation &

Verification


has been optimized?



9/15/2014

13

2. Water Use Control 1. IMPACT ANALYSIS 2. WATER USE CONTROL

How/Where Potential Impacts Optimization Efforts


• Potential for HAI’s associated with water system

• Opportunities to conserve water while ensuring safe conditions

• Cross Functional Team • Hazard Analysis & Control

Sterile processing • Asset Loss: Damage to surgical instruments

• Opportunities to optimize efficiency of steam generation processes

• Ensure RO/DI performance • Confirm steam purity

HVAC/comfort cooling • Opportunities to optimize efficiency of water & energy usage to provide cooling to OR

• Optimize cooling tower water safety for facility and community

• Maximize cooling tower cycles

• Ensure heat transfer surfaces are scale free


9/15/2014

14

1. Hazard Analysis

2. Identification of Critical Control Points

3. Establishment of critical limits

4. Establishment of monitoring plan

5. Establishment of corrective actions

6. Procedures to document

7. Validation, verification, reassessment

Analysis

Design Implementation

Validation Verification

1

2

3

4

5

6

7

New in 2014: NSF International Education Course - HACCP for Building Water Systems HACCP Building Water Standard in Process

Best Practices – Water Safety


9/15/2014

15

CDC Recommendation to Facility Managers Involved In Legionellosis Outbreaks

• HACCP-based Water Management Programs should be developed for ongoing hazard analysis and control to prevent further disease cases

• Since 2000, the CDC has advised facility managers involved in legionellosis outbreaks to apply HACCP principles

• Since 2000, there has not been a reoccurrence in any facility that has followed this recommendation.

Used with permission from:

Claressa Lucas, PhD Centers for Disease Control and Prevention (CDC), Atlanta, GA Division of Bacterial Diseases Environmental Legionella Isolation and Techniques Evaluation (ELITE) Certification Program Coordinator Microbiologist involved in most US legionellosis outbreak investigations June 2013


9/15/2014

16

Best Practices – Sterile Processing • Ensure optimal performance of purified water

streams (e.g., reverse osmosis/deionized water systems)

– Review maintenance schedule and findings/repairs. Are you past due? Are system upgrades pending?

• Confirm steam system operation – Maximize boiler cycles of concentration

– Consider boiler pre-treatment options, with demonstrated ROI

– Condensate profile study (iron, pH in distribution system)


9/15/2014

17

Best Practices– Comfort Cooling

• Target 5 cycles of concentration in cooling tower – 3 to 5 cycles: 17% reduction in

makeup water usage

– Water savings for system using 8 MM gal of MU water annually at 3 cycles if moving to 5 cycles? • 1.4 MM gallons


9/15/2014

18

Hazard

Analysis

Hazard Control

Validation &

VerificationHACCP

Water Safety

Plan

What is the hazard?

How do we

prevent the hazard

from harming

people?

How do we know

the hazard has

been prevented

from harming

people?


Impact

Analysis



Water Use Control

Validation &

Verification


has been optimized?



9/15/2014

19

3. Validation and Verification 1. IMPACT ANALYSIS 2. WATER USE

CONTROL 3. VALIDATION & VERIFICATION

How/Where

Potential Impacts Optimization Efforts Objective Evidence




• Cross Functional Team

• Hazard Analysis & Control

• Environmental & Clinical Surveillance

• Documentation of Disinfectant & Control

Sterile processing

• Asset Loss: Damage to surgical instruments


• Proper RO/DI maintenance

• Confirm steam purity

• Periodic RO/DI Water Analysis

• Steam System Benchmarking






• Cooling System Benchmarking and use of Key Performance Indicators (KPIs)


9/15/2014

20

Validation and Verification: Objective Evidence


9/15/2014

21



9/15/2014

22



9/15/2014

23

Summary: Water Interface in the OR 1. IMPACT ANALYSIS 2. WATER USE

CONTROL 3. VALIDATION & VERIFICATION

How/Where

Potential Impacts Optimization Efforts Objective Evidence




• Cross Functional Team

• Hazard Analysis & Control

• Environmental & Clinical Surveillance

• Documentation of Disinfectant & Control

Sterile processing

• Asset Loss: Damage to surgical instruments


• Proper RO/DI maintenance

• Confirm steam purity

• Periodic RO/DI Water Analysis

• Steam System Benchmarking






• Cooling System Benchmarking and use of Key Performance Indicators (KPIs)


9/15/2014

24

Thank You


The Interface between Water and the Operating Room · 2. Water Use Control . 1. IMPACT ANALYSIS 2....

Documents

Transcript of The Interface between Water and the Operating Room · 2. Water Use Control . 1. IMPACT ANALYSIS 2....