1. Impact of Water Outages and Restrictions on Healthcare Facilities
Presented by:
Jeremy Jernigan
Emergency Management Coordinator
Columbus Regional Healthcare System
& Columbus County Health Department

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

3. Examples of water usage:
Hand hygiene
Medical gas systems
Drinking water
HVAC systems
Ice machines
Decontamination/Hazmat response
Food preparation
Bathing patients
Eyewash
Flushing toilets
Laundry
Cleaning and sterilization of instruments
Dialysis
Fire suppression

4. What types of facilites?
Hospitals
Nursing homes
Assisted living facilities
Dialysis clinics
Dental offices
Doctors offices
Group homes
Home health
???

5. 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

6. Effects of water supply interruptions
Diversion
Evacuation
Cancellation of services

7. Drinking water advisories and notices
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.

8. 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.

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

10. Actions
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

11. Actions
Dishwashing
If a dishwasher does not reach 180 degrees then disposable eating and drinking utensils should only be used

12. 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

13. 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.

14. 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

15. Lessons learned
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

16. 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

17. 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

18. Planning documents
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

19. 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

20. Planning documents
EPA – Planning for an Emergency Drinking Water Supply

21. Regulations related to planning
Center for Medicare & Medicaid Services (CMS) 42 CFR
The Joint Commission 2009 Emergency Management Standards, specifically EM

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

23. Thanks to:
Mark Bennett – NHRMC
Ned Fowler – Mission Health System

24. Questions?
Jeremy Jernigan (O) (C)