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Washer-disinfectors and cart washers are automated machines that clean, rinse and thermally disinfect instrumentation and case carts. They also use large quantities of water. Today’s washer-disinfectors are designed to recycle some of the clean rinse water, but they still need gallons of water for proper function.
Ultrasonic cleaners use potable water to create cleaning solutions that are compat- ible with the cavitation action of the unit. Some ultrasonic cleaners are also capable of rinsing and thermally disinfecting the instrumentation. In these systems, appro- priately treated water is used for the final rinse.
Cleaning and rinsing accounts for most of the water used in SPDs. However, high- level disinfection processes, both auto- mated and manual, also use water to rinse instruments and devices after the cycle. Some sterilization processes also use
water. Steam sterilizers generate steam from tap water, and water is supplied to ethylene oxide systems to humidify the load. Liquid chemical sterilant processing systems use water to create the sterilant use dilution and to rinse the devices at the end of the process.
Lastly, water is used at eyewash stations, for hand hygiene and to create disinfectant solutions to clean department oors, coun- ters and surfaces.
SPDs rely on continuously available potable water to clean, disinfect and steril- ize devices and surfaces. Whether a depart- ment loses water pressure, is placed on a boil advisory or loses water completely, the unexpected change to the water supply can delay all processes within the depart- ment, which ultimately affects the sterile instrument supply and thus, the surgical schedule.
What can happen
When water has become contaminated or the conditions create an opportunity for contaminated water, advisories are issued by the water supplier, local and state governments, EPA or Federal Emergency Management Agency (FEMA). Advisories fall into three categories: Boil Advisory, Do Not Drink Advisory and Do Not Use Advisory.
Boil advisories are issued when a known or potential microbial contamination is present in the water that when ingested may make persons ill. Boiling the water kills the microorganisms, making the water safe to drink. Water can still be used for handwashing, hygiene, cleaning and laundry, but should first be boiled for one minute when the affected geographical area is below 6,500 feet elevation and for three minutes when above 6,500 feet. Do Not Drink advisories are issued when chemicals or toxins in the water will harm a person when consumed. It may still be safe to use the water to ush toilets or wash hands, depending on the chemical or toxin in the water. However, using this water for preparing foods, drinking, oral hygiene, baby formula and ice is prohibited. A Do Not Use advisory indicates that a harmful microorganism, chemical, toxin or radioactive material is in the water that cannot be safely removed with boiling and will harm persons when skin, lungs or eyes contact the water. Healthcare facilities must not use this water for any reason. Contaminants can enter the water supply through a variety of events:
• Broken water lines that allow soil to enter the pipe.
Faulty backow valves or preventors that allow sewage or untreated water to enter the water supply.
SELF-STUDY SERIES
• Flood water from heavy rains and natural disasters that enter the treatment centers and contaminate the water at the origina- tion point.
• Low water pressure that allows con- taminants to enter the water lines through microcracks within the lines. When pres- sure drops below 20 psi for more than one hour, contaminants can ow into the water supply from the cracks.
• Construction crews who strike water mains while digging, causing pressure drops in the system and allowing con- tamination to enter the supply lines.
• Freezing weather for long periods of time that interrupts water supplies. Frozen pipes can impede the ow, but during the thaw the pipes can also burst, and both conditions can leave areas without water.
• Dead animals at the origination of the water or in holding tanks that introduce contamination.
• Earthquakes and fracking that disturb ground water and introduce contamina- tion.
All water advisories stay in effect until the underlying problem is located and corrected and the water is determined to be safe to drink once more. Of the types of advisories that can be issued, the most likely to impact healthcare facilities is the boil advisory.
What are a department’s options when
on a boil advisory? Most boil advisories are short-lived but can still have a significant impact on the facility. A boil advisory will directly affect sterile processing functions and indirectly affect operating rooms because of potential instrument short- ages. Instruments exposed to potentially contaminated water may be subject to increased levels of microbial bioburden. In addition, because the department’s washing, disinfecting, high-level disinfect- ing and sterilizing equipment typically requires potable water for operation, and a boil advisory indicates that the water is no longer potable, this equipment can’t be used during the advisory. Furthermore, any instrument sets that were already processed with potentially contaminated water are considered contaminated and must be removed from inventory, both in sterile storage and assembly areas.
What to do
To minimize the negative surgical conse- quences of a water crisis, SPD and OR man- agers and directors should work together. First, they should take a count of all the available sterile instrument sets in inven- tory and match these to the needs of the
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hpnonline.com • HEALTHCARE PURCHASING NEWS • July 2021 29
Self-Study Test Answers: 1. C, 2. A, 3. B, 4. C, 5. C, 6. A, 7. B, 8. C, 9. A, 10. C
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