How to Run a Hospital — Without Water: A Story Out of West Virginia

 

Used in sanitation, sterilization, hand hygiene, environmental cleaning, laundry and other major processes, water is the life-force for hospital operations. As a result, hospitals have emergency operations plans in place in the event of water contamination. But when West Virginia's water was declared unsafe after a massive leak of the chemical MCHM into the region's Elk River in January, six hospitals and 330,000 West Virginians were nonetheless left reeling. The problem: The contaminant wasn't biological, so there was no way of removing it from the system.

MCHM, or 4-Methylcyclohexanemethanol, is chemical used for scrubbing coal. There is little research into whether or not it is biologically active or toxic, but immediately after the spill West Virginians living along the Elk River reported nausea, vomiting and a persistent smell of licorice.

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South Charleston, W. Va., contains two of the six area hospitals affected by the spill — those of Thomas Health System. "In hindsight, we had the same problem the state had: no idea of safe concentrations [of MCHM]," says Dan Lauffer, Thomas Health System COO. In response to the water crisis, West Virginia released an indefinite advisory: no drinking, cooking with or bathing with the water from the Elk River.

Crisis Management
The advisory sent Thomas Health System into crisis management mode. The two-hospital system activated its emergency protocols and immediately set up command centers to notify management and coordinators about the spill. Other staff and members of the public were notified of the crisis through media accounts. Then, to prevent confusion, mechanical staff manually turned off every faucet in the hospitals' buildings.

After the initial triage, the next step was to determine how to continue performing water-contingent procedures. "It meant thinking a lot farther forward," says Mr. Lauffer. "We had to ask ourselves: At what point do our resources become strained? How do we avoid using water and still remain operational? How well could we manage going forward, given the potential longevity of this particular crisis? What is the risk involved?"

Hand hygiene was a major first priority: "Our goal was to get potable water to every nursing station," says Brian Ulery, vice president of the health system and incident commander for the crisis. Through an ingenious bit of repurposing, staff modified OR pumps to engineer handwashing stations for nurses. Then the hospital distributed sanitizing foam to people who couldn't use nursing station water.

Surgery presented another challenge. Thomas Health System cancelled all elective surgeries for the day after the spill, a Friday, while emergent procedures continued with tools sterilized before the contamination incident.

But sterilized tools were in limited supply, and by mid-Friday morning the hospital grew concerned about emergent surgeries scheduled in the upcoming days, says Mr. Ulery. The hospital reached out to other healthcare organizations in the area, making arrangements to transport surgical tools for sterilization, a process that continued throughout Friday.

However, the community-wide impact of the chemical spill meant this wasn't a sustainable solution. "Saturday morning, we realized the ability of outlying hospitals was not going to be able to bring us back whole for surgeries on Monday," says Mr. Ulery. A lucky discovery from the National Guard determined MCMH evaporates at lower temperatures than those at which surgical sterilizers operate, and the health system was again able to sterilize surgical tools.

Aftermath
All told, the hospitals were without water from Thursday of one week to Tuesday of the next. Mr. Lauffer says he considers the community fortunate. "We were lucky it was this, rather than something more toxic," he says. The affected area received the all-clear early in the week, and by Tuesday, the health system had completed a flushing of its buildings' pipes. It was back to business as usual — mostly. Hospitals along the Elk River may soon be called to participate in medical monitoring of the affected population, though how exactly state and federal governments and regulators will want to proceed is still unclear.

Patient safety aside, there was one other illuminating aspect to the crisis. People living in the community had shown up to the system's hospitals looking for solutions, assuming hospitals would simply have the problem figured out. "It's amazing how hospitals are looked upon as places where things are taken care of, because they have to be. People just expect we have redundant systems and plans in place," says Mr. Lauffer.

The biggest takeaway from the crisis is how important preparation is, according to Mr. Ulery. "Running a hospital in 2014 without running water is something I don't think anyone can meaningfully prepare for....Seeing how people in these hospitals fought through great unknown makes me proud to be part of this [hospital] system and community," he says.

"Going forward, we're going to think about what we did and how we could have managed in a different situation," adds Mr. Lauffer.

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