Water disaster infection control
The water disaster plan developed by infection control professionals in New Jersey includes these recommendations:
Hand Washing and Hand Disinfection
People knowledgeable in the use, advantages, disadvantages, cost, and acceptance of these products should choose products for hand washing and surgical scrubs.
1. Routine hand washing:
A. Alternative agents such as detergent-containing towelettes and alcohol-based waterless hand gels should be made available.
B. If hands are heavily soiled with dirt or heavily contaminated with blood and/or other organic material, wash hands with soap and water to remove organic material (water need not be potable). Hand washing must be followed by use of an alcohol-based waterless gel. Rub vigorously, covering all parts of hands until dry (usually 30 seconds).
C. Use alcohol-based waterless gel instead of hand washing when hands are not visibly contaminated or heavily soiled.
2. Hand antisepsis in high-risk areas. In high-risk areas (i.e., labor and delivery, newborn nursery, burn unit, etc.), bottled water should be used with usual antiseptic agent to achieve hand antisepsis.
3. Surgical scrubs
A. Consideration should be given to performing emergency surgery only.
B. On entering the operating suite, hands should be first treated with an alcoholic hand gel. The subungual spaces should be cleansed with soft wooden sticks.
C. Surgical hand rubs maybe performed by pouring a small volume of suitable antiseptic, usually an alcohol preparation, into the cupped dry hands, rubbing it unto the entire surface of hands and forearms, keeping them wet for the scheduled time by adding portions as necessary, and carrying out wash movements. Brushing an alcohol preparation into subungual spaces increases the effect of disinfection. Alcohol-wet hands should not be gloved but air-dried before donning gloves.
D. There is a limited list of possible agents that can be used for surgical hand rub to achieve antimicrobial efficacy. As a hygienic hand rub, n-propanol alcohol is the most active, followed by isopropanol, ethanol providone-iodine solution, and periacetic acid.
Hemodialysis Units
1. Water contamination:
A. If your water system requires treating water chemically beyond normal levels, advise dialysis units to:
(1) Sample water for chemical analysis to ensure compliance with the Association for the Advancement of Medical Instrumentation (AAMI) standards.
(2) Conduct chlorine/chloramine tests to ensure compliance with AAMI standards.
(3) Monitor water system gauges once per shift.
2. Disruption of water: Discontinue dialysis. Make arrangements for patients to be dialyzed in the closest available centers until water pressure has resumed, and then follow the above plan.
Housekeeping and Laundry
1. Disinfectants should not be diluted with contaminated water: this would increase the bioburden and reduce the effectiveness of disinfectant solutions. Potable water should be used to dilute disinfectants.
2. Institutional laundry operations are dependent on the public water supply. The average conventional washer will use approximately 3½ gallons of water per pound. A tunnel washer uses 1¼ gallons of water per pound and needs 70 Psi of pressure in order to operate.
3. Contamination of the public water supply will not have a huge impact on the operation of an institutional laundry operation. Chemicals used in a hot water wash cycle are sufficient to kill contaminants.
4. There is a potential of sediment in the water supply after a disruption that will turn whites to yellow or light brown. This condition will not change until the water lines are completely flushed. The inlet filters on washers also should be changed after an event.
5. A total loss of the potable water supply will mandate that the institution draw on outside commercial companies for processing linen and personal clothing.
6. Contracts or agreements with outside commercial laundry facilities should be established for emergency situations. Arrangements should be made with more than one company. It is important that the company has facilities outside of the immediate area or has a second plant outside the area of the institution.
7. A notice should be sent to nursing staff to institute conservation efforts on patient floors that may consist of the following:
A. Use of disposable underpads.
B. Use of disposable linen in the operating room.
C. Use of waterless baths to reduce washcloths, bath towels, and sheets.
D. Change sheets on an as-needed basis.
E. Sending personal clothing out for commercial processing should be limited to underwear and heavily soiled clothing
F. The institution’s spare clothing supply can be used to supplement patient clothing needs.
Reference
1. Drapchak J, Ferrer L, Leschek J, et al. Recommendations for Safe Practices during Water Supply Disruption and/or Contamination in Healthcare Facilities. New Jersey; 2001.
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