In the world of modern water management, one of the most complex and regulated systems to manage is hospital water. These programs vary from maintenance, cooling, and boiler water treatment to federally required monitoring associated with Centers for Medicare & Medicaid Services (CMS) requirements.
A well-trained water treatment professional likely has experience with cooling towers and boiler programs on-site, but successfully managing specialized hospital water testing requires a comprehensive understanding of the applicable regulations, standards, and guidance.
Three key areas of hospital water management include CMS compliance and Legionella management, AAMI ST108, and ISO 23500 for dialysis water.
CMS Compliance & Legionella Water Management
When considering the needs of hospital water testing, one of the primary concerns is Legionella management and compliance with CMS guidance, particularly for hospitals subject to 42 CFR §482.42.
A comprehensive water management program includes a facility risk assessment, water management plan, testing and control protocols, acceptable ranges, and corrective actions to address identified deviations.
For a water treatment professional servicing these sites, this may include development of a Water Management Plan, routine testing for Legionella, and appropriate corrective action when deviations are identified.
Beyond Legionella testing, facility risk assessments should identify areas where other opportunistic waterborne pathogens could grow. Examples include Pseudomonas, Acinetobacter, Burkholderia, Stenotrophomonas, non-tuberculous Mycobacteria (NTM), and fungi, although these represent only a portion of potential waterborne pathogens.
When selecting microbiological testing approaches, facilities and their laboratory partners should select appropriate methods based on the system, application, and water management objectives, whether that involves the ISO 11731 Legionella culture method or validated rapid molecular methods.
AAMI ST108 and Water for Medical Device Processing
Beyond Legionella management and CMS guidance, healthcare facilities must also consider water used for medical device processing.
The Association for the Advancement of Medical Instrumentation (AAMI) ST108 standard outlines water quality considerations intended to support the safe processing and reuse of medical devices. ST108 establishes chemical and microbial water quality requirements for water used to rinse, wash, and process medical devices between patients.
This includes routine and periodic analyses designed to evaluate water quality throughout medical device processing systems.
Table 1: Routine AAMI ST108 Water Quality Testing Parameters
Table 2: Annual AAMI ST108 Water Quality Testing Parameters
For a water treatment professional, implementing an AAMI ST108 water testing program may require defining water systems, designating sampling points, and adding additional sampling locations where necessary.
These systems, especially those producing critical water, have stringent water quality requirements. Meeting those requirements may result in the addition or modification of treatment systems, including reverse osmosis, deionization, and sub-micron filtration.
These considerations should also be incorporated into the broader water management approach already developed for Legionella management, helping infection prevention, facilities, water treatment professionals, and other stakeholders work together to address related water quality concerns.
While AAMI ST108 is not itself a CMS regulation, healthcare facilities are increasingly evaluating how its requirements apply to their medical device processing programs. AAMI is also developing TIR119 to provide additional guidance to support implementation of ST108.
Dialysis Water Testing and ISO 23500
The third facet of specialty hospital water management is dialysis water under ISO 23500.
Dialysis involves the external removal of waste, salt, and fluid from the human body. Because patients can be exposed to large volumes of treated water during treatment, maintaining appropriate dialysis water quality is an important component of patient safety.
ISO 23500 establishes requirements and recommendations related to the preparation and quality management of fluids used for hemodialysis and related therapies. Similar to ST108, the ISO 23500 series includes chemical and biological testing requirements depending on the type of water or fluid being evaluated.
Table 3: Dialysis Water and Fluid Quality Parameters
For water treatment professionals and healthcare facilities, dialysis water testing requires careful consideration of the treatment system, sampling locations, monitoring frequency, and applicable quality requirements.
Taking a Holistic Approach to Hospital Water Testing
Hospital water testing is not simply about checking a box. It plays an important role in protecting patients, supporting facility operations, and helping healthcare organizations proactively manage waterborne risks.
Programs addressing Legionella, AAMI ST108, and dialysis water may have different testing requirements and objectives, but they are connected by the need for a thoughtful, facility-wide approach to water quality management.
Working with an experienced laboratory can help healthcare facilities and water treatment professionals navigate testing requirements, select appropriate analytical methods, interpret results, and respond effectively when challenges arise.
Q Laboratories supports healthcare facilities and water treatment professionals with Legionella testing, AAMI ST108 water testing, and dialysis water testing services as part of comprehensive water management programs.
Learn more about Q Laboratories’ Legionella, AAMI ST108, and Dialysis Water Testing Services.
