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Post by H2Otech2 on Sept 1, 2021 9:35:54 GMT
In my part of Maryland we are expected to get 6-8 inches of rain over the next 24 hours. I'm expecting a Boil Water Advisory. I don't recall having one in the last 20 years that I have been doing this. Not here, anyway. Aside from changing Endotoxin filters, checking chloramines more frequently (probably over kill, but we don't always get notified right away when the city hyper-chlorinates) and monitoring water quality, is there anything else I am missing?
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Post by Chuck Weddle on Sept 1, 2021 10:00:23 GMT
In my part of Maryland we are expected to get 6-8 inches of rain over the next 24 hours. I'm expecting a Boil Water Advisory. I don't recall having one in the last 20 years that I have been doing this. Not here, anyway. Aside from changing Endotoxin filters, checking chloramines more frequently (probably over kill, but we don't always get notified right away when the city hyper-chlorinates) and monitoring water quality, is there anything else I am missing? Checking chlorine/chloramine levels at least hourly is all I would say is needed. An intact RO membrane is the best endotoxin filter there is so I wouldn't bother changing them unless you suspect your RO may be compromised. It might not be bad to change your RO prefilter after the event in case there was more silt/sediment stirred up but, you can also just base it off of the delta pressure. What part of MD are you at? Hagerstown/Frederick? I'm based in Baltimore but have clinics from Garrett to Calvert counties. |
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Post by dave74 on Sept 2, 2021 20:25:50 GMT
I found this from the CDC. Can we dialyze patients during a boil water advisory (BWA)? Yes, if the water treatment components in use are sufficient to remove or destroy bacteria, Reverse Osmosis (RO) will protect the product water from having microbial contamination. Deionization (DI) unit does not remove or destroy bacteria, so if DI is being used as the main water treatment (rather than RO), you will need a submicron or endotoxin/ultrafilter downstream of the DI unit. If an ultraviolet (UV) irradiator is used, the filter should be located after the UV irradiator. Close monitoring of the resistivity of the product water will be needed to detect any decrease in quality. Also consider weekly microbial assessment of the product water during the BWA. Keep in close contact with the municipal water supplier because they may choose to “shock” treat (hyperchlorinate) their distribution system to bring it back into compliance with the acceptable standards for drinking water. If the city “shocks” their water system, you may see chlorine/chloramine break through. Review your testing procedures with staff and alert them to be vigilant for potential break through so that patients will be protected from exposure to chlorine/chloramine. www.cdc.gov/dialysis/guidelines/water-use.html |
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Post by Chuck Weddle on Sept 2, 2021 21:00:35 GMT
The CDC and their infinite wisdom!
They say if you use a DI that you will have to have an endotoxin filter downstream.....DING DING DING.....They are already REQUIRED with DI's!
They say if you use UV you need to follow it with an endotoxin filter....Guess what Einstein's?...Yupp....Already required here too!
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Post by Guest1 on Sept 6, 2021 22:57:55 GMT
Pull AAMI sample.
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Post by Chuck Weddle on Sept 7, 2021 9:52:39 GMT
For what purpose? Boil water advisories are because of a potential increase in bacteria, not because of dissolved contaminants. Also, depending on your lab it could take a week or more to get the results. |
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Post by guestCA on Sept 7, 2021 19:43:52 GMT
I would say CYA. It is a major change in water and I agree labs could take a week. Also, having it done ahead of time before the MD or your manager possibly asks is always a plus even if they don't ask at all. AAMI for city and AAMI for RO doesn't cost you except 5-10 minutes total.
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Post by Deleted on Sept 15, 2021 9:58:07 GMT
Just another addition to this. Make sure the ice machine is not used. I have run into this quite a few times under BWAs. I agree with Chuck, an AAMI Chemical Analysis is not necessary with a BWA. As far as the CDC advise goes, increased total chlorine testing (if you do not have a chlorine monitor) is not a terrible idea. Speak with the municipal water provider and get more information on why the BWA is in place. Ask them if they plan on increasing the chlorine/chloramine output to counteract the issue (though by the time the BWA is announced they probably already have). Always remember the Medical Director "owns" the water treatment system, we just maintain it, provide advice, recommendations and monitor its function. You are expected to be the expert on the water treatment system and the Clinical team and most Medical Directors are going to come to you for recommendations and information. Keep yourself informed and keep the lines of communication open. If there is something you don't know look into it. There is a wealth of knowledge out there.
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Post by Deleted on May 25, 2022 14:53:52 GMT
Also you might need to completed another clean/disinfection
The reason behind completing AAMI's would be to verify that no issues have developed while under the boil water order
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