Notice: Guidance for Dialysis Care Providers
What to do when your municipal water supplier issues a "boil
water advisory"
Released: September 17, 2004
What is a "boil water advisory?"
A boil water advisory (BWA) is issued to protect the community from waterborne
infectious agents. A BWA is issued only after careful consideration among
representatives from public health, regulatory agencies, and municipal
departments after positive tests (e.g., positive samples for fecal coliforms,
changes in turbidity measurements) or line breaks.
What should I do when under a BWA?
For personal use, create a supply of water for cooking, drinking, and
tooth brushing by bringing water to a rolling boil for 1 minute. Timing
starts when the water starts to bubble. Cool the water then place in clean
containers for use or refrigerate.
Hot (not boiled) soapy water can be used for dishwashing and kitchen/bathroom
surface cleaning. As a precaution, add one tablespoon of bleach per gallon.
Laundry water does not need to be treated. Unless specifically listed, water
for showering does not need to be treated.
Can we dialyze patients during a 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.
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