Summary
Keeping patients safe isn’t just about cleaning surfaces. It’s also about the water that feeds sinks, showers, and your ice machines. A smart testing plan tells you if your controls and filters are working — before there’s a problem.
Why water testing matters
- Legionella and other germs can grow inside complex hospital plumbing.
- Testing proves your hot/cold temps, disinfectant, and filter setup are doing their job.
- Results guide corrective actions (flush, sanitize, replace a filter, adjust temperature, etc.).
- It’s a core part of a Water Management Plan (WMP) aligned with ASHRAE 188 and the CDC Toolkit.
Where to test in a healthcare facility
Think “source → system → patient areas → endpoints.” Start here:
Building-Level
- Incoming water (baseline quality)
- Hot water loops (at least one per loop)
- Storage tanks / heaters (outlet)
Patient-Care Areas (highest priority)
- ICU, oncology, transplant, long-term care
- Ice machines and ice/water dispensers (upstream of filter, downstream of final bacterial-retentive filter, and ice from the bin)
- Showers and faucets in units serving high-risk patients
Support & Procedure Areas
- Dialysis, respiratory therapy, burn units
- Pharmacy clean rooms (as applicable)
- Kitchen/foodservice (less clinical risk, still important for hygiene and taste)
Quick rule: If water will touch patients (directly or indirectly), or equipment that touches patients, add it to your testing map.
What to test (keep it focused)
A. Microbiological
- Legionella (culture or validated method): confirms microbial safety
- HPC (heterotrophic plate count): trends general microbial load
- Coliform/E. coli (as needed): screens for contamination events
B. Chemical/Physical
- Disinfectant residual (free chlorine or monochloramine): shows ongoing protection
- Temperature (hot and cold): Legionella thrives in lukewarm water
- pH, hardness, TDS: prevents scale/corrosion that can shelter biofilm
- Iron & manganese (if staining or taste issues appear)
How often to test (sensible cadence)
VA facilities: align your cadence with VHA Directive 1061(4). The structure above fits that intent.
Ice machines: special attention
Your ice machine is a known risk point in healthcare. Pair testing with the right filter setup:
- Two-stage filtration:
- Carbon-less sediment pre-filter (5–10 µm) – keeps disinfectant intact
- 0.2 µm “absolute” bacterial-retentive filter – the last barrier before the machine
- Sample points:
- Upstream of filters (incoming quality)
- Downstream of final bacterial-retentive filter (verify barrier)
- Ice from the bin (end-product safety)
•PM order (every service): final filter → pressurized sanitize → pre-filter → clean & descale → no-rinse sanitize
How to collect samples (simple best practices)
- Use clean, labeled bottles (lab-provided if possible).
- Take microbiological samples first, before any chemical tests or flushing.
- Don’t sample right after chemical disinfection unless you’re verifying the result (follow lab guidance).
- For ice, use a clean scoop into a sterile bag, avoiding bin surfaces.
- Keep samples cold and deliver to the lab promptly (follow holding times).
What to do with results (decision tree)
Within limits & negative tests → Keep current schedule; document.
Low disinfectant or warm cold-water temps → Increase flushing, adjust valves, fix mixing issues, recheck in 24–72 hrs.
Scale/corrosion indicators rising → Review softening/pretreatment; descale equipment; inspect filters and pressure drops.
Positive Legionella → Follow your WMP: pressurized sanitize lines, replace filters, increase flushing, consider temporary point-of-use outlets restrictions, retest per policy. Repeated positives? Evaluate secondary disinfection (e.g., chlorine dioxide or copper–silver ionization).
The simplest documentation that still works
Keep a one-page log per location (machine/outlet). Record:
- Date & location
- Parameter (temp, disinfectant, Legionella, etc.)
- Reading & limit
- Status
- Corrective action (if needed)
- Initials
Aldevra offers a free Ice Machine Testing & Monitoring Log Tool you can embed or link. It auto-saves entries, exports to PDF/Excel, and makes survey time easier.
Budget-friendly rollout (good → better → best)
Good: Test quarterly for microbiology in high-risk areas; weekly temps; monthly disinfectant; keep logs. Ensure each ice machine in patient areas has a carbon-less pre-filter + 0.2 µm absolute filter.
Better: Expand testing to more locations; add pressure gauges/quick-connect heads to speed filter changes; add staff refreshers.
Best: Add secondary disinfection building-wide (e.g., chlorine dioxide), plus sensors that track temps and residuals; integrate dashboards with your WMP.
FAQs
Do I still need to clean if I have great test results and filters?
Yes. Filters reduce what gets in; cleaning/descaling removes what grows inside.
Is UV enough by itself?
No. UV doesn’t leave a residual. Keep your 0.2 µm absolute filter at the ice machine and follow your PM routine.
Where do I start if we’ve never tested?
Map patient-care areas first, sample ice machines and nearby outlets, set weekly temp and monthly disinfectant checks, and add quarterly Legionella testing.
Quick checklist to get going this week
List all ice machines and high-risk outlets
Confirm two-stage filter setup on patient-care machines
Start weekly temp and monthly disinfectant checks
Schedule quarterly Legionella tests (begin with high risk)
Launch simple logs (one page per location)
Train staff on ice handling and reporting
Bottom line
A clear water testing plan — focused on ice machines, smart filters, and a few routine checks — lowers risk fast and gives you proof during audits. If you want help, contact Aldevra.
