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

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

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

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

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

Effects of water supply interruptions Diversion Evacuation Cancellation of services

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.

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.

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

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

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

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

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

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

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

Regulations related to planning Center for Medicare & Medicaid Services (CMS) 42 CFR 482.41 The Joint Commission 2009 Emergency Management Standards, specifically EM.02.02.09

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

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

Questions? Jeremy Jernigan (O) 910-640-4649 (C) 910-398-0223 jjernigan@crhealthcare.org