to where it needs to be to better ensure patient safety and extend the life of our devices.”

Understand and Analyze Your Water It is imperative that ASC personnel comprehend the two types of water used in ASC reprocessing to under- stand different potential treatment needs, Harmer says. “There is ‘util- ity’ water, which comes from the tap. It is used mainly for flushing, wash- ing and rinsing. Utility water might require treatment to achieve needed quality specifications. The second type of water is ‘critical water,’ which is treated extensively to ensure that the inorganic and organic materials and microorganisms are removed.


water is mainly used for steam genera- tion or the final rinse.” To understand water quality, ASCs must perform an analysis, Harmer says. “Bring in a qualified service provider with expertise in water quality to deter- mine whether your water requires treat- ment and, if so, what type of treatment. All water is not the same, and all water does not have the same problems.” Kaiser says ASCs can contact their

detergent or washer vendor or a local water testing lab to perform the assess- ment. Whichever vendor is brought in should understand which parame- ters of water quality are important for ASC reprocessing. “At a minimum, analyses per-

formed should indicate the total hard- ness, chloride and metal content of the water,” he says. “The vendor should sample the water at the most infor- mative points. For example, water used for diluting detergents should be sampled at the closest point where the water enters the facility; before and after water passes through a hot water heater to check for corrosion in the heater; and at the point where the water is used.”

be tested and the water for your steam generation should be tested.” ASCs also will want to perform scheduled audits of water quality throughout the year, and perform test- ing in a standardized fashion, Harmer says. “Not only can water quality differ throughout a facility, but the tempera- ture of the water can have a significant impact on the effectiveness of repro- cessing medical devices. Water can change seasonally as well, such as when there is runoff due to snow and ice melt- ing. You do not just test water once.”

Implement Treatment Processes Following the assessment,


should work with vendors to imple- ment treatment processes that will pro- vide the type of water quality neces- sary to meet the device reprocessing needs of the facility, Harmer says. Troubleshooting water issues is not a straightforward process, Kaiser says. “ASCs should consult with their ven- dors for help in interpreting analyses and troubleshooting water systems.” Hinkle says her ASCs have made

many changes based on the recom- mendations of their vendor partners. “They made recommendations for how to treat our water to resolve the issues we were facing. By following their rec- ommendations, we have helped keep our patients safe and seen our equip- ment last longer.”

Assure Quality Throughout Since device reprocessing occurs in several stages, ASCs will want to make sure water quality is addressed throughout the facility, Harmer says. “The water treatment solution for one area may not be the same treat- ment needed for other areas,” she says. “The same water does not come out of every spigot. As such, the water in your decontamination sink should be tested, the water that is going into your washer decontaminator should

Perform Ongoing Monitoring A regular water monitoring sched- ule and recording system, Kaiser says, makes troubleshooting water qual- ity concerns easier. Hinkle says her ASCs have their water quality assessed monthly. “My water happens to have a lot of minerals in it. By having our water assessed regularly, we are confi- dent that we will avoid problems.” Kaiser recommends alarming puri- fication systems. “There have been cases where a de-ionized water system was stored in a closet and no one knew it had been exhausted for months. A properly alarmed or monitored system would have helped to avoid the prob- lems that ensued.” Water quality can be an excellent

topic area for a quality improvement project, Harmer suggests. “When you perform the audits, you evaluate the results to determine whether you are accomplishing what you needed to, or if a new issue has developed that requires your attention. Then you use monitoring procedures to ensure the water quality is what you need for your reprocessing.” “I cannot emphasize this enough,” she adds, “Water treatment cannot be a once-and-done process. Essentially, all water coming into an ASC is bad. It is up to ASCs to ensure that the water used for reprocessing does not jeopar- dize the delivery of quality care.”


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