St. Mary s Hospital, Camrose LOSS OF WATER SUPPLY EMERGENCY RESPONSE PLAN

Transcription

1 Facilities Maintenance & Engineering Switchboard / Designate Supervisor / Manager aware of Water Supply concerns St. Mary s Hospital, Camrose LOSS OF WATER SUPPLY EMERGENCY RESPONSE PLAN LOSS OF WATER SUPPLY EMERGENCY RESPONSE PLAN ALGORITHM Instruct Staff to: Verify status of patients and that critical patient care equipment is functioning. Follow Staff Action swim lane Report water supply concerns: Report water supply concerns to on-site Facilities Maintenance & Engineering or Switchboard / or Designate afterhours Advise staff to implement Area / Unit water contingency plan. Refer to relevant Area / Unit Checklist, within this Plan. Upon notification: Notify Facilities Maintenance & Engineering ( ) Notify Site Administration / Administrator On-Call of nature and impact of water supply concern ( / ) Notify Infection Prevention & Control Notify Protective Services, (if Protective Services not on-site call Covenant Health Protective Services Manager ) When advised by Site Administration, announce (sample script): Attention please, the site is under a water advisory. Please implement your water contingency plan. Please check your Area / Unit and report any service issues to Switchboard or FM&E. Other pages and actions as requested by Site Administration / Administrator On-Call When requested by Site Administration / Administrator On- Call, announce Attention please: The water supply has been restored. However, assume the water is not safe to drink until otherwise notified. Upon notification of a water supply issue: If a water outage, report outage to water utility to determine if it is a supply or site issue ( ) o Check for obvious physical damages to water distribution equipment if not a water utility issue o Check grounds and surrounding area for any construction or operations that may disrupt water services if not a water utility issue Notification of unsafe water advisory may have been received from Environmental Public Health Follow Checklist 1 Undertake Site Impact Assessment Appendix I Report findings to Site Administration / Administrator On-Call, afterhours Developed by AHS and adapted for Covenant Health Page 1 of 38

2 Staff Actions when Notified of a Loss of Water Supply LOSS OF WATER SUPPLY EMERGENCY RESPONSE PLAN ALGORITHM Upon receiving notification of a Loss of Water supply: Show a calm and reassuring manner. Reassure patients / visitors of the situation* (see suggested script, below) Verify status of patients and that critical patient care equipment is functioning. Check for: o Low suction pressure and / or low pressure in the medical vacuum / air lines ( ) o Loss of water pressure in taps, toilets, etc. o Discoloration, unusual taste or odour of water Access clinical resources as necessary (i.e. portable electric suction, seek alternate to piped in medical air if pressure is low, due to loss of water pressure) Label water sources which should not be used during the disruption: o All Public Area sinks / faucets should be labeled DO NOT DRINK (Appendix II) o All public / visitors bathrooms should be labelled DO NOT USE (Appendix IV) If necessary, water from non-potable sources can be used for forced toilet flushing for patient and staff bathrooms. Ice machines should be labelled DO NOT CONSUME during disruption (Appendix III). Any ice made before the disruption should be considered contaminated and should be destroyed. (Appendix VI) o If a planned event, disconnect the ice machine before water disruption. o Consider substituting the use of commercially acquired cold packs for cold treatment applications. Bathing of patients should be at the discretion of Supervisor / Manager. o Use alternative bathing methods, such as commercial bath in a bag products or moist towelette (baby wipes). Hydrotherapy treatments should be discontinued because the high organic load of the water supply will affect the antiseptics commonly used during treatment. Clinical and Non-clinical areas are to reference relevant Area / Unit Checklist for water contingency plan. Report actions / assessment to Supervisor / Designate If you are away from your work space when hearing the Loss of Water Supply announcement, you are asked to return to your own work space, if it is safe to do so and report to your Supervisor / Designate. *Script for Patients/Visitors: We are currently under a water advisory. We have the situation under control and are continuing to provide services as usual. Your safety is our top priority and we will advise you immediately if we need to do anything further. Please speak with your nurse if you need to access the toilet, bathing, or need drinking water. After receipt of return of service notification, note that you must assume the water is not safe to drink until otherwise notified: If, after an appropriate amount of time, the water services are still not restored, notify Switchboard / Facilities Maintenance & Engineering. Staff to verify status of patients and that critical patient care equipment (suction, medical air, dialysis, Medical Devices Reprocessing) have been returned to normal operations Developed by AHS and adapted for Covenant Health Page 2 of 38

3 Protective Services or Site Specific Designate LOSS OF WATER SUPPLY EMERGENCY RESPONSE PLAN ALGORITHM Follow Checklist 2 Confirm with Facilities Maintenance & Engineering (FM&E) the impact of the water supply concerns to Site Ensure fire suppression systems are unaffected with FM&E. Establish Fire Watch if required (Appendix IV) Assist with placement of advisory signage as requested by Site Administration / Administrator On- Call Support and assist staff as required Remain engaged with Site Administration / Administrator On-Call, requesting additional resources / personnel, if needed Consult with Area Supervisor / Site Administration / Administrator On-Call when to declare event concluded and to have return of service announced Developed by AHS and adapted for Covenant Health Page 3 of 38

4 Site Administration / Administrator On-Call Confirm water supply concern and impact to Site Follow Checklist 3 Confirm Site Facilities Maintenance & Engineering is aware Confirm site Infection Prevention & Control is aware Initiate Site internal communication plan Confirm Administrator On-Call is aware Determine need to establish Site Command Post to coordinate actions and communications to staff Ensure notification to Senior Leadership, Communications, and RAAPID Engage Emergency/Disaster Management On-Call to escalate response In consultation with engaged parties determine when incident has partially and/or fully resolved: Water may be returning to the system, but not yet considered safe to consume. Therefore a Boil Water Advisory may need to be considered by Environmental Public Health, until testing indicates the water is safe to consume. Switchboard / Designate may be instructed to announce return of service, noting limits on the use of the system s water. Ensure all documentation has been completed Site: St. Mary s Hospital, Camrose Approval Level: Covenant Health E/DM Cross Reference: ERC Green Document #: ERP 5 Initial Effective Date: August, 2016 Revision Effective Date: August, 2016 PURPOSE To describe the response to water supply disruption and/or contamination. Developed by AHS and adapted for Covenant Health Page 4 of 38

5 APPLICABILITY Compliance with this is required by all Covenant Health employees, members of the medical and midwifery staffs, students, volunteers, and other persons acting on behalf of CovenantHealth (including contracted service providers as necessary). This Emergency Response Plan does not limit any legal rights to which you may otherwise be entitled. ACTIVATION The Loss of Water Supply Response Plan can be initiated by any member of staff or physician by following the preceding algorithms. The order in which notification occurs will depend on the particular circumstances of the situation. However, FM&E and IPC should always be notified immediately in order for mitigation measures and strategies to be implemented. Specific responses are shown at the appendices. RETURN TO NORMAL FUNCTIONING ALL DEPARTMENTS Once full or partial service is restored and under the direction of the Site Administration / Designate, Switchboard / Designate ( ) will convey the appropriate advisement Attention please: The water supply has been restored. However, assume the water is not safe to drink until otherwise notified. Facilities Maintenance & Engineering (FM&E) will coordinate the return of the Site to normal operations. Depending upon how long the water has been out, the water may run dirty for a period of time Water will start to flow to all open sinks, some toilets may remain open until FM&E can repair them; ensure all faucets are turned off Site Administration will conduct a debriefing of the incident. All comments regarding this incident follow-up should be forwarded to the appropriate Site Personnel POST INCIDENT ACTIONS For a facility impacted by a loss of water supply, the Site Administration or Administrator On-Call is to complete incident documentation as follows: Reportable Incident Form (seniors sites). Urgent Notification of an Emerging Issue (all other sites). Other site or zone-specific documentation as appropriate. Advice on document completion may be sought from Emergency/Disaster Management on-call or from the Administrator On-Call (during evenings and weekends). Emergency/Disaster Management staff may also be contacted for assistance in facilitating the post incident debriefing. Checklists Developed by AHS and adapted for Covenant Health Page 5 of 38

6 Facilities Maintenance & Engineering (Checklist 1) Protective Services / Security(Checklist 2) Site Administration / Administrator On-Call (Checklist 3) Communications (Checklist 4) Nutrition and Food Services (Checklist 5) Diagnostic Imaging Services (Checklist 6) Surgical Suites (Checklist 7) Respiratory Services (Checklist 8) Laboratory Services (Checklist 9) Laundry and Environmental Services (Checklist 10) Medical Officer of Health & Environmental Public Health (Checklist 11) Contract Procurement Supply Management (Checklist 12) Infection Prevention and Control (Checklist 13) Patient Care Unit (Checklist 14) Medical Device Reprocessing (Checklist 15) N.B. All other Departments / Services not listed above, please refer to the following checklist. Departments Not Specifically Identified in Previous Checklists (Checklist 16) Appendices Site Impact Assessment (Appendix I) Signage DO NOT DRINK (Appendix II) Signage DO NOT CONSUME (Appendix III) Signage DO NOT USE (Appendix IV) Loss of Water Supply Fire Watch Program (Appendix V) Guidelines for Healthcare Facilities during a Boil Water Advisory (Appendix VI) Hand Hygiene during a Water Interruption or Boil Water Advisory (Appendix VII) Developed by AHS and adapted for Covenant Health Page 6 of 38

7 Checklist 1 FACILITIES MAINTENANCE & ENGINEERING Contact FM&E On-Call Manager and advise them of the situation Ensure Site Impact Assessment is completed (Refer to Site Impact Assessment Contingency Planning Template Appendix I) Contact the Site Administration / Administrator-On-Call, informing them of assessment outcomes Ensure all Fire Suppression Systems are functioning. Arrange for temporary water supply, if possible, to support: o Boilers o Fire Suppression Systems N.B. If required, contact the Fire Department to coordinate assistance with water supply Contact IT if any computer rooms are being affected. Arrange potable water delivery, as directed by Site Administration / Administrator On-Call. The water hauler is to be approved by Environmental Public Health, based on current licensing. o Note: the chemistry of the delivered water must be acceptable to the manufacturers of specialized medical equipment (i.e. Dialysis, MDR) Relay the outcomes of any action strategies to the Site Administration / Administrator On-Call Assess the need for drinking water for your Staff Relay requests for supplies to Site Administration / Administrator On-Call Follow advisories as issued by Environmental Public Health Continue to communicate status of event to Site Administration / Administrator On-Call Assist with the coordination of returning the Site to normal operations: o Flushing of water lines o Checking toilets after a prolonged outage as some of the sensors have been known to trigger constant flushing and water problems / flooding floors o If internal loss of pressure has occurred, make sure the sprinkler system has been bypassed before recharging to prevent the triggering of any false fire alarms o Testing of water in cooperation with Environmental Public Health o Other Document all actions taken and decisions made Conduct a Post Incident Analysis with department staff Submit report including any recommendations and future action plans to Site Administration Refer to Site-Specific FM&E considerations Developed by AHS and adapted for Covenant Health Page 7 of 38

8 PROTECTIVE SERVICES / SECURITY Checklist 2 Consult with Facilities Maintenance & Engineering and assess impact of loss of water and / or unsafe water supply on the provision of services to the Site Contact the Covenent Health Protective Services Manager ( ) as an advisory and possible back up Assess the need for: Personnel o Assess the need for additional staff for: Manning a Fire Watch (only if water supply issue) Posting Internal and External Signage Assisting with the delivery and storage of critical supplies Preparing for restrictions to site access Refering media inquiries to Corporate Communications Contacting off duty personnel, as required Supplies o Assess the need for drinking water for your Staff Relay your service assessment and need for supplies and additional resources to Site Administration / Administrator On-Call Assign personnel to Fire Watch ; provide handout of role / responsibilities (Fire Watch Assignment Sheet and Roles and Responsibilities Appendix V) Post signage as directed by Site Administration / Administrator On-Call Communicate status of current service to Site Administration / Administrator On-Call Document all actions taken and decisions made Conduct a Post Incident Analysis with department staff and submit a report including any recommendations and any future action plans to the Site Administration. Developed by AHS and adapted for Covenant Health Page 8 of 38

9 SITE ADMINISTRATION/ADMINISTRATOR ON-CALL Checklist 3 Ensure notification to Senior Leadership, Communications, and RAAPID; include Medical Officer of Health Activate and staff the Site Command Post; consider the following: Clerical Support Medical Officer of Health (MOH) / Environmental Public Health (EPH) Corporate Communications Facilities Maintenance & Engineering (FM&E) Infection Prevention & Control (IPC) Contract Procurement Supply Management (CPSM) Protective Services (PS) Emergency Medical Services Supervisor (EMS) Assist Communications by: o Identifying target audiences (staff, Physicians, current and future patients, families, and the general public) as deemed necessary o Identifying methods of communicating (i.e. , signs, hand delivered messages, phone, fax, overhead page, etc.) o Coordination of services in preparing messages Consider need to call a Site briefing meeting (use overhead page to request that area representatives report to a designated area for a briefing) Access Site Impact Assessment from FM&E FM&E may be asked to arrange a potable water delivery to support the Site. The water hauler is to be approved by Environmental Public Health, based on current licensing. o Note: the chemistry of the delivered water must be acceptable to the manufacturers of specialized medical equipment (i.e. Dialysis, MDR) Ensure Dialysis services at the Site are notified of the water supply disruption so they can initiate their operational procedures to safeguard their systems o Using single-use dialyzers and suspending the hemodialyzer re-use program (for dialysis facilities that usually reprocess hemodialyzers for reuse); Receive and analyze potable water requests for all the Units / Departments o Hand Hygiene (alcohol-based hand rub must be available) o Toilet flushing o Automated waste disposal units (bedpan flushers) and need for disposable products o Environmental Services / Terminal cleaning o Drinking water for Staff / Patients / Medication Administration: Calculate 2 litres per patient per day for drinking (4 bottles of 500 ml per patient per day) Arrange for a minimum of 2 bottles (min 500 ml each) for each staff member per each 8 hour shift Developed by AHS and adapted for Covenant Health Page 9 of 38

10 Consult with Site Command Post membership on ways of reducing water consumption should loss of water be the issue. Consider need to relocate or divert services based on outcome of Site Impact Assessment. Some examples of potential water conservation measures for use when it is appropriate, safe, and possible to do so include: o Cancelling elective procedures; o Limiting radiology developers to essential use only; o Using alcohol-based hand rub products according to established infection control guidelines; o Sponge-bathing patients; o Using disposable sterile supplies; o Using portable toilets (i.e. for staff and / or visitors); o Transferring noncritical patients to unaffected facilities; o Limiting the number of ED/UCC patients and / or using the ED/UCC to triage patients for transfer to other appropriate facilities (Note: the need for this will depend on the duration of the water supply interruption); o Postponing physiotherapy services that require hydrotherapy; and o Shutting off the water supply to buildings that do not support critical functions. o Discontinuing laundry services o Utilizing single service utensils in the kitchen to limit dishwashing o Eliminating outdoor water usage (plants, gardens, etc) o Limiting / eliminating food preparation by non-nutrition Food Service groups (Recreation Therapy, Nursing, Women s Auxiliary etc.) o Determine which toilets and sinks will remain open and which will be closed o Assess the need to close all public toilets and supply outdoor portable toilets for public use o Assess the need for signage and tape for toilet closures Contact all Units / Departments for the impact their scheduled services (Refer to specific Checklists): Assist with dissemination of information and compliance of staff with any advisories issued by Environmental Public Health In consultation with engaged parties determine when incident has partially and/or fully resolved: o Water may be returning to the system, but not yet considered safe to consume. Therefore a Boil Water Advisory may need to be considered by Environmental Public Health, until testing indicates the water is safe to consume. o Switchboard / Designate may be instructed to announce return of service, noting limits on the use of the system s water. Assist with the coordination of returning the Site to normal operations Schedule an incident debriefing, which incorporates feedback from appropriate Site personnel Developed by AHS and adapted for Covenant Health Page 10 of 38

11 Checklist 4 CORPORATE COMMUNICATIONS Consult with Site Administration / Administrator On-Call and Medical Officer of Health, on status of the facility, and service impacts Identify the need for any immediate internal messaging and/or external media releases Consult with Site Command Post members re key messages o Message considerations Source of problem Estimated duration of problem, if known Contact information for Site Command Post Actions taken to date (i.e. Fire Watch in place, Pumper Unit supplying water to boilers, postponement of elective procedures, etc.) Actions to be taken (i.e. Food Services will be providing cold meal, Laboratory tests will be sent to another site, etc.) Environmental Public Health Advisories Infection Prevention & Control precautions, if applicable Reduction, relocation, diversion or suspension of services When to expect next update Identify target audiences, internal and external: o Internal audience considerations Site Medical Staff, Residents, Medical Students Patients Contractors working on the Site Contracted Service Providers Others as deemed necessary o External audience considerations: General public In conjunction with the MOH, assist in the development / issuance of any Public Health Orders related to water usage Future patients Post secondary schools for scheduled student placements Media Others as deemed necessary Establish communication link with Communications Staff at the Municipality Consider need for additional staff and call for assistance as needed Coordinate Media relations with support of Site Administration / Administrator On-Call Monitor all broadcast media for accurate information Developed by AHS and adapted for Covenant Health Page 11 of 38

12 Provide ongoing updates at regular intervals or as directed o Status of the Site (Service Impact) o Status of surrounding communities o Updates on Situational Status o Information on partial restoration of services, if applicable Document all actions taken and decisions made by Communications Conduct a Post Incident Analysis with department staff and prepare brief report Submit report with recommendations and any future action plans your department may be considering to the Site Administration. Developed by AHS and adapted for Covenant Health Page 12 of 38

13 NUTRITION AND FOOD SERVICES Checklist 5 Consult with staff and assess how the loss of water supply has, or may impact the provision of your services: Equipment: o Assess all equipment that is steam-fed or requires a water feed Supplies: o Assess availability of paper plates, trays, cups and disposable utensils and estimate how soon re-supply will be necessary o Conduct inventory of current bottled drinking water / juices, etc. and estimate how long these supplies will last o Assess the need for drinking water for your Staff o Conduct inventory of current water supply for hand washing o Coordinate access of supplies / materials to ensure appropriate hand hygiene: Hand wash stations (Appendix VII) Disposable gloves Facility: o Identify which toilets and sinks will remain open and which may be closed. Post signage as necessary (Appendix II; Appendix IV) o Post signage on ice machines (Appendix III) o Assess ability to keep surfaces disinfected (Appendix VI) Assess ability to provide the next meal, identify any required menu changes Estimate the number of meals that can be served utilizing your existing food stores Contact Site Administration / Administrator On-Call to report: o your assessment of your area o drinking water needs of Staff o required resources, information o action plan for the area (meal delivery, changes in schedule, etc.) Follow advisories as issued by Environmental Public Health o During a Boil Water Advisory refer to AHS NFS Boil Water Advisory Standard Patients and employees should not consume water that has not been disinfected, ice or drinks made with water that has not been disinfected, or raw foods rinsed with water that has not been disinfected. Use bottled water or disinfect water by boiling at a rolling boil for 1 minute. Coffeemakers can be used if they can be brought to and maintained at a temperature of 65 C for 10 minutes. Some coffeemakers have built-in temperature Developed by AHS and adapted for Covenant Health Page 13 of 38

14 gauges; if using a coffeemaker without a gauge, a method must be established to ensure that these parameters are met. Carbonated beverage units should be shut off. Disinfect dishes via dishwashing machines that have a dry cycle or a final rinse that is NSF approved. Recommending final temperature rinse is at 82C for 10 seconds. Contract Procurement Supply Management: Supports sourcing and delivery of bottled water and ice Recreation Therapy: Food preparation programs will be discontinued during Boiled Water Advisory or Do Not Drink Advisory. Provide ongoing updates to the Site Administration / Administrator On-Call Consult Environmental Public Health, Infection Prevention & Control and Facilities Maintenance & Engineering to determine actions required once event has concluded. Refer to AHS NFS Boil Water Advisory Standard o Run cold water through all fixtures with a direct water line for at least one minute. o For ice machines: Flush inlet lines for one minute If this is not possible, run three consecutive ice making cycles Disinfect ice machine with a 200 ppm bleach solution (1 tsp bleach/1l of water). Allow to air dry. Rinse bin and contact surfaces with clean water. o Run all water softeners through a regeneration cycle. o Drain and refill hot water heaters that are set below 45 o C. Document all actions taken and decisions made Conduct a Post Incident Analysis with Department Staff Submit report including any recommendations and any future action plans that your department may be considering to the Site Administration Developed by AHS and adapted for Covenant Health Page 14 of 38

15 DIAGNOSTIC IMAGING Checklist 6 Consult with staff and assess how the loss of water supply has, or may impact the provision of your services: Equipment: o Assess impact on equipment used Supplies: o Assess the need for drinking water for your Staff o Coordinate access of supplies / materials to ensure appropriate hand hygiene: Hand wash stations (Appendix VII) Alcohol-based hand rub Disposable gloves Facility: o Identify which toilets and sinks will remain open and which may be closed. Post signage where applicable (Appendix II; Appendix IV) o Assess ability to maintain sanitation in area (Appendix VI) Contact Site Administration / Administrator On-Call to report: o your assessment of your area o drinking water needs of Staff o required resources, information o action plan for the area Follow advisories as issued by Environmental Public Health Provide ongoing updates to the Site Administration / Administrator On-Call Document all actions taken and decisions made Conduct a Post Incident Analysis with Department Staff Submit report including any recommendations and any future action plans that your department may be considering to the Site Administration Developed by AHS and adapted for Covenant Health Page 15 of 38

16 SURGICAL SUITES Checklist 7 Consult with staff and Facilities Maintenance & Engineering (FM&E) if necessary, to assess how the loss of water supply has, or may impact the provision of your services: Equipment: o Assess impact on Medical Air supply (consult FM&E / Anaesthesia) o Assess impact on suction units, if loss of water pressure is experienced (consult FM&E / Anaesthesia) o Other anaesthesia equipment, sterilizers, reprocessing Supplies: o Assess ability to replenish sterilized instruments o Assess the need for drinking water for your Staff o Coordinate access of supplies/materials to ensure appropriate hand hygiene: Hand wash stations (Appendix VII) Disposable gloves Facility: o Identify which toilets and sinks will remain open and which may be closed. Post signage where applicable (Appendix II; Appendix IV) o Assess ability to maintain sterility / cleanliness in area (Appendix VI) Consult with Medical Staff re action plans and determine the priority and level of service(s) that can safely be provided Contact Site Command Post / Administrator On-Call to report: o your assessment of your area o drinking water needs of Staff o advise on hand washing contingency plan o required resources, information o action plan for the area Follow advisories as issued by Environmental Public Health Provide ongoing updates to the Site Administration / Administrator On-Call Document all actions taken and decisions made Conduct a Post Incident Analysis with Department Staff Submit report including any recommendations and any future action plans that your department may be considering to the Site Administration Developed by AHS and adapted for Covenant Health Page 16 of 38

17 RESPIRATORY SERVICES Checklist 8 Consult with Facilities Maintenance & Engineering staff and assess how the loss of water supply will impacted the provision of your service area. (Appendix I) Equipment: o Assess the number of portable suction units required within the facility, if the water disruption has caused a loss of suction pressure. Assist Distribution Services in prioritizing the assignment of available suction units, as required N.B. Assess if EMS/Inter-Facilities Transport could become an additional resource for suction units. o Determine the need for oxygen tanks / regulators if there is a loss of medical air caused by the water disruption and a resulting loss of pressure: How many units will be required? Determine the internal transportation of air tanks Supplies: o Assess the need for drinking water for your Staff Contact Site Command Post / Administrator On-Call to report: o your assessment of your area o drinking water needs of Staff o required resources, information o action plan for the area Follow advisories as issued by Environmental Public Health Provide ongoing updates to the Site Administration / Administrator On-Call Document all actions taken and decisions made Conduct a Post Incident Analysis with Department Staff Submit report including any recommendations and any future action plans that your department may be considering to the Site Administration Developed by AHS and adapted for Covenant Health Page 17 of 38

18 LABORATORY SERVICES Checklist 9 Consult with staff and assess how the loss of water supply will impacted your services: Equipment: o Assess the ability to maintain sterilization processes o Assess the functional capabilities of lab equipment ALERT: Some fridges may be cooled by circulating chilled water. If impacted, find alternate space for storage of products. Supplies: o Assess the need for drinking water for your Staff Facility: o Identify which toilets and sinks will remain open and which may be closed. Post signage where applicable (Appendix II; Appendix IV) o Assess ability to maintain sterility / cleanliness in area (Appendix VI) Consult with Staff re action plans and determine the prioritization and level of services to be provided o Assess the need for off site processing of Urgent / Stat lab specimens Contact Site Administration / Administrator On-Call to report: o your assessment of your area o drinking water needs of Staff o required resources, information o action plan for the area Follow advisories as issued by Environmental Public Health Provide ongoing updates to the Site Administration / Administrator On-Call Document all actions taken and decisions made Conduct a Post Incident Analysis with Department Staff Submit report including any recommendations and any future action plans that your department may be considering to the Site Administration Developed by AHS and adapted for Covenant Health Page 18 of 38

19 LAUNDRY AND ENVIRONMENTAL SERVICES Checklist 10 Consult with staff and Infection Prevention & Control (IPC) to assess how the loss of water supply will impact your services: Equipment: o Assess how cleaning equipment will be impacted (floor cleaning machines) Supplies: o Take inventory of the amount of disposable disinfectant wipes in stock o Identify those services that may be deemed essential o Assess what additional supplies should be ordered to maintain essential cleaning o Assess the need for drinking water for your Staff Facility: o Assess the need for suspension of some of your services o Prioritize the Units / Departments that will require the continuance of essential cleaning standards o Assess the need to accommodate an increase volume of disposable waste from Units / Departments Contact Site Administration / Administrator On-Call to report: o your assessment and action plan for your services o drinking water needs of Staff o required resources, information Follow advisories as issued by Environmental Public Health Provide ongoing updates to the Site Administration / Administrator On-Call Document all actions taken and decisions made o Housekeeping disinfectants should not be diluted with contaminated water: this would increase the bio-burden and reduce the effectiveness of disinfectant solutions. Potable water should be used to dilute disinfectants. o Institutional laundry operations are dependent on the public water supply. Do not use residential / non-commercial machines. Contamination of the public water supply will not have a tremendous impact on the operation of an institutional laundry operation. o Chemicals used in a hot water wash cycle are sufficient to kill contaminants. o There is a potential of sediment in the water supply after a disruption that will turn whites to yellow or light brown. This condition will not change until the water lines are completely flushed. The inlet filters on washers should also be changed after an event. o Contracts or agreements with outside commercial laundry facilities should be established for emergency situations. Arrangements should be made with more than one company. It is important that the company has facilities outside of the immediate area or has a second plant outside the area of the institution. Developed by AHS and adapted for Covenant Health Page 19 of 38

20 o A notice should be sent to nursing staff to institute conservation efforts on patients floors that may consist of the following: Use of disposable under-pads. If available, use disposable linen / draping in the operating room. Use of waterless bathing products to reduce wash cloths, bath towels and sheets. Change sheets on an as-needed basis. Use of single-use medical devices, if Medical Device Reprocessing services are impacted. Sending personal clothing out for commercial processing should be limited to underwear and heavily soiled clothing. Consult IPC and Facilities Maintenance & Engineering to determine actions required once event has concluded: o Cleaning of ice machines (Appendix VI) o Draining and refilling equipment with water reservoirs Conduct a Post Incident Analysis with Department Staff Submit report including any recommendations and any future action plans that your department may be considering to the Site Administration Developed by AHS and adapted for Covenant Health Page 20 of 38

21 MEDICAL OFFICER OF HEALTH & ENVIRONMENTAL PUBLIC HEALTH Medical Officer of Health: Checklist 11 Work with Environmental Public Health to coordinate communication with the Municipal Water Services to: o Evaluate the potential public health impacts to AHS facilities and the community o Assess the type of amount of water interruption Communicate with the Site Administration / Administrator On-Call regarding the assessment of the situation health impact of water loss / unsafe water supply on facility and community Determine the need for the issuance of a Water Advisory Coordinate with Corporate Communications re internal and external communiqués: o Status of the Site (Service Impact) and surrounding communities o Updates on Situational Status o Information on partial restoration of services, if applicable Work with Environmental Public Health Staff in the assessment of food services practices, alternate potable water supplies and remediation activities Environmental Public Health: With the Medical Officer of Health, evaluate the degree of public health impact of water loss / unsafe water supply on AHS facilities and community Equipment: o Liaise with Food Services to determine dishwasher operation and hand washing o Liaise with Facilities Maintenance and Engineering (FM&E) re: Provision of temporary toilets and hand washing stations Location and disconnection of ice machines / water using vending machines Supplies: o Evaluate any and all alternate potable water supplies that may be considered for the facility Facility: o Monitor facility compliance with Water Advisories i.e. sign posting & distribution o Evaluate bottled water sources and hygienic distribution Contact Site Administration / Administrator On-Call to relay your assessment and request any additional supplies / resources that will be needed Developed by AHS and adapted for Covenant Health Page 21 of 38

22 Communicate status to Site Administration, MOH and appropriate departments / businesses Liaise with Site Administration / FM&E on reconnections and implementation of flushing procedures Document all actions taken and decisions made Conduct a Post Incident Analysis with Department Staff; submit report (recommendations and any future action plans) to the MOH / Site Administration Developed by AHS and adapted for Covenant Health Page 22 of 38

23 CONTRACT PROCUREMENT SUPPLY MANAGEMENT Checklist 12 Consult with staff to assess how the loss of water supply will impact your services: Supplies: o Collect and coordinate requests for essential medical equipment / supplies from hospital departments o Assess and prioritize what supplies need to be ordered to maintain essential services o Assess the need for drinking water for your Staff Facility: o Assess areas that can be utilized for storage of incoming essential supplies o Assess the need for dock space for incoming supplies Contact Site Administration / Administrator On-Call to report: o your assessment of your services, as well as other department requests for additional supplies / resources o drinking water needs of Staff o action plan for the area Requisition delivery of bottled water from contracted vendor Access supplies needed for hand wash stations (dispensing and collection containers) Arrange for the transportation of immediate equipment / supply requests Coordinate the distribution of equipment / supplies Follow advisories as issued by Environmental Public Health Provide ongoing updates to the Site Administration / Administrator On-Call Document all actions taken and decisions made Conduct a Post Incident Analysis with Department Staff Submit report including any recommendations and any future action plans that your department may be considering to the Site Administration Developed by AHS and adapted for Covenant Health Page 23 of 38

24 INFECTION PREVENTION AND CONTROL Checklist 13 Consult with Medical Officer of Health / Environmental Public Health in order to evaluate the degree of public health impact due to the loss of water / unsafe water supply Equipment: o Work with Units / Departments to assess equipment / hygiene / patient care impact (i.e. medical device reprocessing and renal dialysis) Supplies: o Assess Hand Hygiene needs. This includes: Hand wash stations (Appendix VII) Alcohol-based hand rubs for staff Hand wipe towelettes Facility o Consult Environmental Services with regard to: Areas that require cleaning (prioritization) Availability of existing pre mixed quantities of disinfectant Use of disposable cloth disinfectants Areas for sanitary waste storage and protocols for removal of this waste Assess IPC requirements for staff caring for patients with isolation or critical care needs Assess IPC requirements for patients (i.e. hand hygiene) Assess the functioning of toilets and sinks and provide direction for use by patients, staff, and others. This includes restricts on bathrooms and sinks or the need for portable toilets Assess IPC requirements for Nutritional and Food Services handling Assess the need for disposal of human wastes and assist Environmental Services with identifying areas for sanitary waste storage and protocols for removal of this waste Consult with Corporate Communications and Environmental Public Health for preparation of messages and communiqués Contact Site Administration / Administrator On-Call to: o relay your assessment of above o request any additional supplies / resources Follow advisories as issued by Environmental Public Health Disseminate / communicate status updates to appropriate departments / staff Assist with requirements for return to normal state of operations (lab results of water testing, flushing of water lines, cleaning of water reservoirs / ice machines, etc.) Developed by AHS and adapted for Covenant Health Page 24 of 38

25 Document all actions taken and decisions made Conduct a Post Incident Analysis with Department Staff Submit report including any recommendations and any future action plans that your department may be considering to the Site Administration Developed by AHS and adapted for Covenant Health Page 25 of 38

26 PATIENT CARE UNIT Checklist 14 Consult with staff and assess how the loss of water supply will impact your Unit Equipment: o Assess the ability to maintain medical air / suction (consult with Facilities Maintenance & Engineering (FM&E) / Respiratory Services) o Ice machines to be closed off (consult with Infection Prevention & Control (IPC) / Environmental Services) (Appendix III) Supplies: o Report to the Site Administration / Administrator On-Call with the amount of bottled water required for your patients and Staff o Access additional disposable supplies (i.e. disposable bedpans, waterless bathing products) from Supply Management if needed o Calculate a minimum of 2 litres per patient per day for drinking (4 bottles of 500 ml per patient per day) o Calculate a minimum of 2 bottles of water for each staff member per each 8 hour shift Facility: o Identify which toilets and sinks will remain open and which will be closed. (consult with IPC for further direction). Post signage where applicable (Appendix II; Appendix IV) o Assist Environmental Services in prioritizing areas to be cleaned Follow advisories as issued by Environmental Public Health Restoration of water supply o Once full or partial service is restored and under the direction of the Site Administration / Designate, Switchboard will make the appropriate overhead announcement. o Assume the water is not safe to drink until otherwise notified. o FM&E will coordinate the return of the Site to normal operations. Depending upon how long the water has been out, the water may run dirty for a period of time o Water will start to flow to all open sinks, some toilets may remain open until FM&E can repair them o Ensure all faucets are turned off Document all actions taken and decisions made Conduct a Post Incident Analysis with Department Staff Submit a report including recommendations and future action plans that your Unit may be considering, to the Site Administration Developed by AHS and adapted for Covenant Health Page 26 of 38

27 MEDICAL DEVICE REPROCESSING Checklist 15 Contact next level of management (i.e. MDR Manager, Director) and Site Administration to apprise of situation Consult with Infection Prevention & Control (IPC) and Facilities Maintenance & Engineering (FM&E) to assess how the loss of water / unsafe water will impact service area and what level of service can safely be delivered. Equipment o Assess if water and steam will be off to all machinery o Assess if hot and cold water is available in the decontamination area for hand washing of instruments Note: If water is not available in the decontamination area, contact satellite reprocessing areas to see if they have water service. If so, use their sinks for cleaning. Supplies o Identify with Supply Management which supplies can be replaced with disposable (gowns, basins and trays) o Consult with other sites to determine where instruments can be sent for reprocessing o Coordinate with AHS Transportation for the transport of instruments to/from other sites o Identify with main customers Surgical Suites, Emergency and Labour and Delivery, to identify the instruments that must be kept on site o Evaluate staffing needs and schedule additional staff as required o Assess the need for water for your Staff Facility: o Identify which staff toilets and sinks will remain open. Post signage where applicable (Appendix II; Appendix IV) Follow advisories as issued by IPC and Environmental Public Health Provide ongoing updates to the Director, Site Administration / Administrator On-Call Document all actions taken and decisions made Conduct a Post Incident Analysis with Department Staff Submit report, including any recommendations and any future action plans that your department may be considering to the Site Administration Developed by AHS and adapted for Covenant Health Page 27 of 38

28 DEPARTMENTS NOT SPECIFICALLY IDENTIFIED IN PREVIOUS CHECKLISTS Checklist 16 Consult with Department / Service Manager re assessment of the following: o how the loss of water will impact your services (patient care, surgery, endoscopy, etc) o the need for your service to remain intact in lieu of the stress on available resources o are staff able to perform work from an unaffected site Site Administration / Administrator On-Call to be advised of any intended service reduction / diversion / relocation Should retention of services be required, consult with Staff and assess the following: Supplies: o Assess the need for water for your staff and patients Facility: o Identify which toilets and sinks will remain open and which will be closed. Post signage where applicable (Appendix II; Appendix IV) o Assess ability to maintain sanitation in area Contact Site Administration / Administrator On-Call: o relay the assessment of your service area o request any additional supplies/resources o advise of any reduction/limitation to services Follow advisories as issued by Environmental Public Health Continue to communicate status update to Site Administration / Administrator On-Call Document all actions taken and decisions made Conduct a Post Incident Analysis with Department Staff Submit report including any recommendations and any future action plans your department may be considering to the Site Administration. Appendix I Developed by AHS and adapted for Covenant Health Page 28 of 38

29 SITE IMPACT ASSESSMENT: CONTINGENCY PLANNING TEMPLATE Site: Name of Person Completing Assessment: Date Completed: yyyy-mon-dd Time Completed: Service / Function Impacted Replacement Required Drinking Water Yes No Non-potable Water (bathing, environmental cleaning) Yes No Toilets / Waste Disposal Yes No Resources Required Vacuum Yes No Suction Yes No Medical Air Yes No HVAC Yes No Boilers (Heating) Yes No Fire Suppression Systems Yes No Diagnostic Imaging Yes No Medical Device Reprocessing Yes No Laboratory Yes No Renal Dialysis Units Yes No Food Services Yes No IT Infrastructure Yes No Yes No Developed by AHS and adapted for Covenant Health Page 29 of 38

30 Appendix II WARNING Do Not Drink or Use This Water. Developed by AHS and adapted for Covenant Health Page 30 of 38

31 Appendix III WARNING Do Not Consume Ice or Water from this Ice Machine. Developed by AHS and adapted for Covenant Health Page 31 of 38

32 Appendix IV PLEASE NOTE This washroom is out of service. Please proceed to: Developed by AHS and adapted for Covenant Health Page 32 of 38

33 Appendix V LOSS OF WATER FIRE WATCH PROGRAM DEFINITION Where Fire Protection Systems are out of service, the building shall be provided with a Fire Watch. This is for all occupants and all areas of the building left unprotected by the shutdown, until the Fire Protection Systems have been returned to service. PROTECTIVE SERVICES RESPONSIBILITIES the local Fire Department and the monitoring Company MUST be notified when a Fire Protection System is out of service ALSO when it is returned to service advise Site Administration / Administrator On-Call of issue and commencement of program ensure logs are maintained (refer to Fire Log Sheet attached to document). Reproduce as many copies as is needed FIRE WATCH The person/s performing the Fire Watch must have a designated Supervisor available and shall: o Be identified to Facilities Maintenance & Engineering and Protective Services, providing phone numbers for immediate contact o Be easily identifiable to building occupants by uniform or clothing o Be able, and capable, of promptly notifying emergency agencies and occupants of an incident o Maintain a chronological, written log of activities (refer to attached Fire Log Sheet ) on site for the duration of the Fire Watch The Fire Watch shall be in attendance at all times when Fire Protection Systems are out of service, and have sufficient staff to patrol all areas of the building involved, using the following as minimum guidelines: o Non residential buildings; during normal business open hours; every 30 minutes, other times every 60 minutes. o Buildings with sleeping accommodation, including hospitals, Fire Watch must be continuously on site: Between hours every 15 minutes Between hours every 30 minutes The Fire Watch shall have a method of alerting building occupants, making them of what it will be (i.e. Air Horn, etc). Developed by AHS and adapted for Covenant Health Page 33 of 38

34 All building occupants shall be notified of Fire Protection System shut downs or when equipment is out of service. Maintain the Fire Log Sheet complete the following: - name of facility - location of facility - area assigned - frequency of patrols - time of each patrol - name of person conducting each patrol - record all communications sent or received Submit Fire Log Sheet(s) to Supervisor when Fire Watch is cancelled CANCELLATION OF FIRE WATCH The Supervisor, in consultation with Site Administration, Fire Department and others as deemed necessary, will cancel the Fire Watch. Developed by AHS and adapted for Covenant Health Page 34 of 38

35 FIRE WATCH PROGRAM FIRE LOG SHEET Facility Name: Address: Area Assigned: Frequency of patrol: 15 / 30 min. (circle) Date () Time (24 hr ) Watch Person Notes; Record of communications Sent or Received Developed by AHS and adapted for Covenant Health Page 35 of 38

36 Appendix VI GUIDELINES FOR HEALTHCARE FACILITIES DURING A BOIL WATER ADVISORY The following is provided to Healthcare facilities as information in the event a Boil Water Advisory has been issued to your facility or community. To prevent the spread of the disease, care-givers must: 1. Boil for 1 full minute, all water used for drinking, making juice and other beverages, infant formula, making ice, and for washing ready-to-eat fruits and vegetables. This also includes water used for brushing teeth. o Throw away any ice and beverages that may have already been prepared with the affected water supply. o Water can be boiled the night before, and cooled overnight at room temperature or in the refrigerator. o Bottled water from an approved source is also acceptable. o Tea, coffee and other beverages that are prepared with hot water heated to 65 C for 10 minutes are acceptable (a typical domestic coffee maker may be safe to use). o Disconnect all drinking fountains, pop dispensers with post-mix service and ice making machines using regular tap water from the affected water supply. 2. Observe good hand hygiene. o Use warm running water and soap to wash hands before food preparation, after the washroom, and before and after every diaper change. o It is important to dry hands thoroughly - use single use paper towels. o If water is not safe for drinking, and is used to wash hands, then alcohol-based hand rub is to be used after hand washing. o As an alternative to soap and water, other than those situations indicated above and if hands are not visibly soiled, they may be disinfected using an alcohol-based hand rub with at least 60% alcohol. 3. Infection control o Use boiled or disinfected water to wash broken skin, rashes, and wounds and for other similar patient care activities. o Commercially bottled water is not sterile. Consider using sterile-bottled, boiled or otherwise disinfected drinking water for severely immuno-compromised patients. o Monitor patients closely for symptoms of gastrointestinal infection (two or more diarrhea episodes per day, stomach cramps, nausea, vomiting or a slight fever). What to do after the boil water advisory is lifted? o Flush all water-using fixtures, drain, flush, and disinfect any water reservoirs. o Run cold water faucets and drinking fountains for at least 1 minute before using the water. o Run water softeners through a regeneration cycle. Developed by AHS and adapted for Covenant Health Page 36 of 38