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Water quality for medical device reprocessing AAMI TIR34:2007
Contaminant Bacteria
Endotoxin Level
≤ 10 CFU/mL <10 EU/mL
Total Organic Carbon (TOC) <0.05 mg/L (ppm) PH
n/a
Water hardness Resistivity
Conductivity
Ionic Contaminants Chloride Iron
Copper Manganese Source: AAMI TIR34-2007
nants from tap water in order to provide the specified water for each system in your sterile processing department. There are many different specifications
for the processes used in healthcare facili- ties. This means there will be many different components that make up a “high purity water” system. The actual contaminants in your feed (tap) water will be a factor in determining the components and the ap- plication specifications.
Where do you start? To learn more about the water in your department, you should start with a baseline analysis of the water you currently have. Most equipment and deter- gent manufacturers will conduct a water analysis of your department if you request it. This will assist in helping you choose the appropriate cleaning products, trou- bleshooting problems with current processes, and establishing a base- line in an effort to avoid future problems. In order to assure a thorough report, you need to obtain samples from make-up water, fi- nal rinse, steam conden- sate return, and boiler water, so they can be analyzed for their chemi-
<1 ppm as CaCO3
>1,000,000 ohm/cm <1 uS
<0.2 mg/L (ppm) <0.2 mg/L (ppm) <0.1 mg/L (ppm) <0.1 mg/L (ppm)
cal properties. Some manufacturers can also perform an analysis of surgi- cal wraps and instruments. This will determine the cause of deposits or scales on the instruments (the wraps and instruments are typically not returned when you submit them for analysis).
There are other reasons to do a wa-
ter analysis in your department. For example, you may want to consider requesting a water analysis if you are a new manager and a baseline analysis has not been done. This is especially important if you are having issues with instrument spot- ting, staining, and corrosion. Or, if you are undergoing construction or renovation, a water analysis might also provide valuable information. You should also consider performing an analysis if they are doing a major construction project elsewhere in the
hospital that involves the plumbing and steam lines. Also, when you are making decisions about detergents and the dosing of those detergents, a water analysis could help you save on the amount of detergent and water you use.
Building the optimal water treatment system
When making a determination of what type of treatment system to use, the desired quality and quantity of output needs to be considered. The design of the system for your department should plan for:
SELF-STUDY SERIES
• Routine equipment maintenance • Routine monitoring of water quality • Requirements for the system for incoming water quality
• Maximum and minimum pressure allowances
• Inlet flow rate • Drain size • Electrical needs In addition, the water treatment system should be located, if possible, in a secure area immediately adjacent to where it will be used, in order to minimize the length and complexity of the distribution piping. Sche- matic diagrams identifying components, valves, sample ports, gauges and meters should be available, and flow direction should be indicated on the drawing. This is especially important in new construction and renovation, because the architect and engineers will want to account for the treat- ment system in their drawing.
In addition to the removal of organic and inorganic contaminants, the design of the water treatment system may require micro- bial considerations. The system components will usually have storage and distribution loop functions that need to be addressed in the design as well.
Monitoring to maintain quality Bacterial contamination is a persistent problem with high purity waters systems. Bacteria grow well in the nutrient-poor environment of a high purity water system. They establish and build biofilm structures that provide a self-sustaining community that can be very difficult to remove. Main- tenance and monitoring of these systems is critical for long-term quality performance. Procedures must be established for main- tenance and replacement of components that will ensure that the product water continues to meet specifications. Water treatment equipment monitoring is part of a quality assurance program and should be performed by water maintenance personnel daily. In addition, the monitoring and measuring equipment itself needs to be inspected and calibrated on a regular sched- ule. You should keep logs on monitoring, maintenance, replacement and disinfection of your high purity water system. The table on the next page is a general layout of what should be monitored on each component, how often and what parameters should be met. Typically, the equipment manufacturer works with the customer to set up a specific log for their system.
Example of water treatment systems for the SPD Photo courtesy AmeriWater, Inc. (SUEZ Environnement)
See SELF-STUDY on page 34
www.hpnonline.com • HEALTHCARE PURCHASING NEWS • January 2013 33
Self-Study Test Answers: 1. A, 2. D, 3. A, 4. E, 5. F, 6. E, 7. B, 8. C, 9. D, 10. D
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