EC 09 - Safely Maintaining Normal Hospital Functions During a Boil Water Advisory: Collaboration, Risk Assessment and Communication

Background: Contaminated drinking water can lead to waterborne illness outbreaks. When there is confirmed or potential contamination of municipal water, a boil water advisory (BWA) is used to inform the affected community that the public water might be compromised. If a BWA impacts a healthcare facility, it is essential to evaluate and distribute the available municipal and bottled water supply to safely maintain healthcare services while maintaining hazard communication.

Methods: When a BWA was issued the day before a holiday weekend, a multidisciplinary healthcare team including Infection Prevention, Regulatory, Facilities, Surgical Services, Nursing and Dialysis developed a risk assessment to ensure that hospital operations could continue safely. A plan for recommissioning plumbing fixtures and equipment was developed and implemented. The team reconvened after the event for a summation of the exercise and to identify successes and opportunities.

Results: After assessing each risk, the operating suite, cardiac catheterization lab, dietary, and certain inpatient units were provided with portable sinks. Bottled drinking water was provided to patients and staff for consumption. The risk assessment of Central Sterile Reprocessing, High Level Disinfection, and Dialysis determined that those operations could continue. When necessary, handwashing was followed by the use of alcohol based hand sanitizer. Additional provisions for special patient populations and discharge education to patients was provided. At the conclusion of the BWA, waterlines were flushed and filters were replaced. At summation, provision of potable water was successful with no adverse events. Opportunities for improvement were identified in incident command, communication and supply reserve.

Conclusions: A multidisciplinary risk assessment can guide water usage during a BWA to provide safe potable water and continue facility operations while maintaining infection prevention standards. This BWA event served as an exercise in preparedness, assisted in identifying opportunities that can be applied in the future, and demonstrated the value of a risk assessment.