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Page 1 of 2 1 BOIL WATER EVENTS 2 Checklist for Dental and Medical Offices 3 4 If a boil water notice has been issued for drinking water supplied to your office, there is a potential 5 for exposure to water borne pathogens for your patients, staff and the public. 6 7 As a medical professional, your first duty when a boil water notice is issued is to determine 8 whether to remain open. If you cannot ensure that your patients, staff and the public will be 9 protected from exposure to potentially contaminated water, you should consider closing until 10 your water is again potable and fit for use. If you must remain open to provide essential 11 services, or if you elect to stay open to continue treating your patients, you must make sure 12 every appropriate precaution is taken to eliminate all possible exposures. Here are actions that 13 will help you to evaluate and control exposures: 14 Identify all procedures and equipment that use tap water or ice made from tap water. 15 Include equipment and procedures that use tap water for operational processes, sanitizing 16 processes, solutions, and rinse water. Use standard infection control practices to evaluate 17 modes of exposure to tap water or ice for all clientele and staff. Review any applicable 18 facility emergency plans and procedures. 19 Identify all equipment, water tanks, and appliances that received tap water during or just 20 prior to the boil water event. If appropriate, isolate and/or drain equipment. 21 Identify and as appropriate clearly sign and isolate all sinks, spigots, ice machines and 22 fountains. 23 Provide boiled (and then completely cooled) or bottled water for clients and staff to wash 24 their hands in restrooms. Antimicrobial products that do not require water for use (e.g. 25 alcohol based hand rubs) are less effective. If sanitary facilities cannot be provided for 26 patrons and staff, the establishment should close unless it is a critical facility. 27 Some medical equipment that is properly installed, operated, and maintained may provide 28 additional treatment of the tap water for normal equipment operations that may be 29 sufficient to operate without the need for boiling or other supplemental disinfection 30 Others may require adjustments or modifications to do so. Examples could include 31 equipment with reverse osmosis filtration and dialysis equipment. Please refer to the 32 manufacturer’s specifications and your technical support staff to determine any appropriate 33 precautions. Do not use if you are unsure whether your treatment equipment is sufficient 34 and properly maintained. 35 36 Do not use tap water for drinking, cooking, solutions, patient preparation, equipment preparation, 37 equipment operations, hand washing, and office procedures without appropriate precautions. 38 Do not use tap water for oral solutions, contact with open wounds or sores, internal 39 treatment or contact within body cavities, patient rinsing, and hand washing. If practical, 40 use boiled water, bottled water, or water from a safe alternate source.* 41 Do not deliver tap water through the dental operative unit, ultrasonic scaler, or other 42 equipment that uses the tap water. 43 The recommended treatment step for tap water during a boil water event is to bring the 44 water to a full roiling boil for 1 minute, then allow the water to cool before use. This may 45 take 20 or 30 minutes, so plan ahead. 46 ---PAGE BREAK--- Page 2 of 2 Any solution or equipment prepared with water during or just prior to the boil water event 1 should be evaluated further before use. 2 Any ice made or mixed with ice made since the boil water event should not be used. If the 3 age of the ice is uncertain, do not consume or use and label as unsafe for consumption. 4 Drain and disconnect the ice machine. If the ice does not have a critical use, such as 5 cooling medication, discard it. 6 Make sure all staff on all shifts understand and implement all needed measures. 7 NSF listed commercial dishwashers are acceptable if they were manufactured and are 8 operated with a hot wash (170F) at least 8 minutes in duration and use a disinfectant. 9 “Green” or “Environmentally Friendly” dish washer rinse additives or sanitizers are 10 weaker disinfectants and should not be relied upon to eliminate potential pathogens. 11 Adjust or eliminate procedures that are hard to perform with limited water. If appropriate, 12 switch to an acceptable water treatment process or an acceptable alternate water supply, 13 such as bottled water, and bagged or pre packaged ice from a safe alternate source. 14 Tap water can be used to wash the floors and walls, but should not be used for sanitary 15 surfaces. Sanitary surfaces should be washed with boiled or bottled water. 16 17 After the boil water event is over, the facility must be properly purged to fully eliminate the 18 potential contaminants. All potentially affected equipment must be flushed, disinfected as 19 appropriate, and potentially contaminated water/ice discarded. As medical facilities serve people 20 that are already ill or immunocompromised and may have unique equipment and plumbing, there 21 may be additional precautions that your facility should take. 22 23 Flush all water lines for at least 15 minutes, and then wash sinks, fountains, faucets and 24 spigots. If your service connection is long or complex (like an office building), consider 25 flushing for a longer period. Your building superintendent or landlord should be able to 26 advise you on longer flushing times. 27 Appliances, such as your water heater, water filters and water tanks, should also be flushed 28 of at least two tank volumes. Any water filters should have their media backwashed or 29 replaced per the manufacturer’s recommendations. 30 All potentially affected equipment that uses tap water, such as your medical equipment, 31 solution machines, beverage machines, dishwasher, and ice machines, should be flushed 32 and disinfected per the manufacturer’s recommendations. This should include dedicated 33 water lines and tubing. Run equipment a full cycle and flush contents to waste. 34 Sanitary surfaces, patient contact surfaces, surfaces that will come into contact with 35 utensils and medical tools, and ice bins should be cleaned with a disinfectant solution. 36 37