Resolute Advisory Group LLC
San Antonio, Texas
Water quality matters in endoscope reprocessing. The water that is safe for drinking may not be suitable for reprocessing flexible and semirigid endoscopes in healthcare settings. The purity of water is crucial. Impurities such as dissolved organic and inorganic solids, microbial contaminants, and chemical substances can significantly affect the reprocessing of reusable medical devices if they are not properly managed.
Given that water quality varies widely from one location to another, it is essential for endoscopy reprocessing personnel to understand how their organization manages water quality issues. Poor management can adversely affect their work and potentially contribute to shorter lifespans of the equipment, and even cause negative patient outcomes.
On Jan. 1, 2022, The Joint Commission introduced new water management standards (EC.02.05.02, Eps 1-4). These standards aim to enhance the quality and safety of care provided to immunocompromised patients, incorporating water management measures that influence medical device reprocessing.
In addition, the Association for the Advancement of Medical Instrumentation provides a technical information report TIR34:2014/®2021, which offers guidelines for the quality of water required at each stage of medical device reprocessing—cleaning, rinsing, disinfecting, and sterilizing. This resource also addresses water distribution, storage, quality control measures, and bacterial control, making it helpful for central sterile processing personnel and facilities maintenance teams involved in water treatment.
For municipal water systems, water is a finite resource that is recycled over time. Public water systems often contain additives from that recycling process, such as chlorine and dissolved salts, along with naturally occurring minerals and, in some cases, harmful contaminants, such as heavy metals, synthetic organic chemicals, and biological parasites.
Municipal water left untreated by a healthcare system can lead to the buildup of hard water deposits, which are difficult to dissolve and can cause corrosion and damage to medical devices (Table 1). Moreover, untreated water can promote the growth of opportunistic pathogens, including Escherichia coli, Legionella, and nontuberculous mycobacteria.
| Table 1. Consequences of Poor Water Quality |
| Hard water deposits and scaling |
| Increased microbial load and endotoxin levels |
| Corrosion and pitting of devices |
| Reduced life expectancy of equipment |
| Decreased effectiveness of cleaning agents |
| Deterioration of the water system |
| Increased workload and longer reprocessing times |
| Delays in patient care |
| Extended procedure durations |
| Risk for infections |
| Exposure to toxic substances |
Managing Your Water
Healthcare organizations typically treat their water in some way—whether through distillation, reverse osmosis, or deionization. The treatment methods employed can have a significant impact on device integrity and patient care. It is essential to monitor water quality to confirm that control strategies are effective.
Developing a comprehensive water management plan is now a requirement under The Joint Commission’s new standards. Using this plan, facilities should assign individuals or teams to oversee and implement water management protocols. Essential components of the plan include risk assessments, testing protocols, and acceptable ranges to minimize pathogenic biological agents in various water systems.
Responsibilities for water management include creating diagrams mapping water supply sources, treatment systems and end-use points. This plan must include an evaluation of the physical and chemical conditions for each step in the water flow diagram. The plan also must be reviewed annually and revised as needed.
Stakeholders in Water Management
A multidisciplinary team is critical for effective water management. This team may include representatives from areas such as building management, facilities engineering, infection prevention, and microbiology, as well as experts from specific clinical areas. Clear roles and responsibilities, along with a mission statement, will guide the team in effectively managing water quality and mitigating unnecessary costs (Table 2).
| Table 2. Seven Steps to a Creating A Water Management Plan | |
| 1 | Create a team |
| 2 | Map the water system |
| 3 | Identify risks |
| 4 | Develop strategies to mitigate those risks |
| 5 | Monitor and respond to changes |
| 6 | Review the plan periodically |
| 7 | Document all actions and maintain accurate records |
Effective water management is essential for healthcare organizations to ensure the safety and quality of patient care. By adhering to established standards, understanding the intricacies of water treatment, and collaborating across disciplines, organizations can mitigate risks associated with poor water quality. This proactive approach not only enhances device reprocessing efficacy but also safeguards patient health, ultimately leading to better healthcare outcomes.
This article is from the December 2024 Priority Report print issue.