Westfields Hospital Case Study for an Emergency Use Well

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Westfields HospitalCase Study for an Emergency
Use Well
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Documents for Review

• Guidelines for Healthcare Facilities for the
  Management of Water Emergencies
• Submittal Information for Review Health Care
  Facility Water Emergency Supply
• Health Care Facility Emergency Supply Policy and
  Procedure Overview
• Westfields Hospital Water System
  Failure/Compromise

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Demonstration Project

• Westfields Hospital, New Richmond, served as a
  demonstration project to identify Lessons
  Learned for well projects at smaller hospitals.
• Saint Josephs Hospital, Marshfield, and Aurora
  Medical Center, Kenosha, are currently completing
  their demonstration projects and will also
  provide Lessons Learned for larger hospitals

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Westfields Hospital Emergency Use Well

• Their well can produce sufficient water to
  maintain normal operations for both potable and
  facility water, e.g. boilers, etc.
• The well can
• produces a maximum of 65 gallons per minute (gpm)
• is connected to emergency back-up power
• can be activated within minutes to maintain water
  supply for the entire facility.

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Learning Objectives

• To describe why wells are a cost-effective option
  for hospitals
• To describe the steps a hospital should take in
  considering whether to establish a well
• To describe the eligibility criteria to receive
  federal hospital preparedness funds to help
  subsidize the cost of a well

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Prerequisite Guidelines

• Hospitals are advised to be familiar with the
  Guidelines for Healthcare Facilities for the
  Management of Water Emergencies
• This was produced by the State Expert Panel on
  the Management of Water Emergencies, which
  included
• Hospital Plant Operations
• Environmental Protection Agency
• Department of Natural Resources
• Department of Commerce
• Water Utilities

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Prerequisite Water Emergency Plan

• The hospital should have a Water Emergency Plan
  before considering which options best fit the
  unique circumstances of their facility
• The Guidelines provide recommendations for the
  various components of this plan

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Why Does a Hospital Need a Well?

• To provide an emergency water source in the event
  of
• Loss of water pressure
• Loss of water
• Contamination of water

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Options for Water Supply

• The hospital must ensure it has both
• potable water
• water for facility operations
• The State Expert Panel on Water Emergencies has
  identified the pros and cons of various options
• Complete details about pros and cons of each
  option can be found in the Guidelines

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Options for Water Supply

• Wells
• Bottled Water
• Tankers
• Booster Pumps
• Portable Disinfection/Filtration Systems
• Alternate Potable Water Sources
• Storage Tanks

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Wells A Preferred Option

• Wells provide many advantages over other options,
  but may not be the best or only option. Some
  advantages include
• reliable source of both potable and facility
  water
• cost-effective in many situations
• state has well-defined regulations for wells for
  emergency use
• will help to address the Joint Commission 96
  water supply

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Wells Not for Every HospitalMonroe Clinic and
Hospital

• The area for their well would be in the same
  aquifer as one of the city wells. This would mean
  that if the city water from this well is bad - so
  would theirs.
• The city well shares a property line with the
  facility and is its main supply. It has has a
  gasoline powered back-up pump so it can serve the
  facility in a power outage.

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Wells Not for Every HospitalMonroe Clinic and
Hospital

• The main from the city well goes across its
  property and along its property line so for the
  most part if it gets cut, the facility did it.
• Two other wells out of six in the city have
  electrical generator back-up
• The city can operate on 3 wells at any given
  time.
• The city will send water to the facility main
  first in cases of emergency

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What Will It Cost?

• It is estimated that a well for smaller hospitals
  will cost 30,000 to 40,000
• A complete break-down of costs for Westfields
  Hospital will be explained later in this
  presentation
• Once the larger hospital demonstration projects
  are completed, estimates for larger well projects
  will be made available to hospitals.

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What Is Available from Hospital Preparedness
Funds?

• A total of 40,000 will be made available in two
  parts
• Part A Design and Submittal provides funding of
  up to 15,000 and involves completing all designs
  and plans and submittal of these to the
  Department of Commerce
• Part B Well Implementation provides funding of
  up to the balance of 40,000 for the actual
  drilling of the well, purchase and installation
  of pump and connections to hospital plumbing and
  electrical generation

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Funding Note

• Although reimbursement for actual expenses up to
  15,000 is available, it is expected that costs
  for Part A may be closer to 8,000
• Thus, the hospital would have available 7,000
  for costs associated with Part B in addition to
  the 25,000 available for Part B.
• total available is 40,000

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8 Steps to Building a Well
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Step One Complete a Water Usage Assessment

• Recommendations for a water assessment are found
  in the Guidelines
• Record of daily water usage
• Worksheet A of the Guidelines helps the
  hospital to identify
• major users of water by area/function
• total percentage of water used by each
  area/function
• isolation or restriction options, e.g. shut-off
  valves
• Criticality (full, intermittent, shut off)

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Step One Complete a Water Usage Assessment

• Hazards Vulnerability Analysis should document
  which events may cause water problems
• Mapping of Water Feeds and Valves
• Hospital Plan integrated with the plan of the
  local water utility
• Water Conservation Plan

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Step Two Support of Administration

• The hospital must provide a Letter of Support
  from Administration stating
• the hospital is willing to accept funding at
  least for Part A Design and Submittal
• will commit to building the well if
  cost-effective
• will cover any cost over-runs above the 40,000
  subsidy from Parts A and B
• will estimate time-line for project
• recognize that this is a major project for Plant
  Operations (160 hours estimated)

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Step Three Letter of Support from the Local
Water Utility

• The support of the local water utility is key
• Although state statutes support the building of a
  well, the hospital should not want to begin this
  project without the support of the local water
  utility
• DNR Legal Opinion of May 23, 2009

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DNR Regulations
NR 812.09(4)(a) Approval required for the
construction or operation of a high capacity well
or well system. A hospital well system used for
emergency purposes that has a capacity of less
than 70 gallons per minute is governed by Chapter
NR 812 and does not require a specific approval
to construct unless a variance to a specific
provision of NR 812 is necessary.
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Memorandum of Understanding

• Some water utilities have requested the hospital
  enter into a Memorandum of Understanding with the
  local water utility
• This is to help protect the local water utility
  by stating that these wells are for emergency use
• this is an option that is available if so
  requested by the local water utility
• a sample MOU is available

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Step Four Requirements of the Department of
Commerce

• The hospital must meet the requirements of the
  Department of Commerce (a complete checklist is
  available)
• A letter of explanation to inform the reviewer of
  the design intent
• A completed General Plumbing application
  (SBD-6154)
• Appropriate plan review fees

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Step Four Requirements of the Department of
Commerce

• 2 copies of plans and 1 copy of specifications
• Plan view of emergency water supply system from
  well to point of connection
• Isometric view of emergency water supply system
  from well to point of connection
• Detailed engineering specifications
• Emergency Operations Plan that identifies
  plumbing fixtures and other water usage available
  during a water emergency
• Well capacity along with well pump discharge rate

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Funding Note

• The Hospital can apply for Part B Funding only
  upon approval of all plans by the Department of
  Commerce

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Step Five Engineering

• The hospital may need the assistance of an
  engineering firm to help with water usage
  calculations and drawings

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Westfields Engineering Costs 7,965

• water flow calculations for entire hospital
• domestic water isometrics of entire building,
  including fixture unit counts
• drawings of well locations and entry to building
• review existing plans of hospital and architects

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Westfields Engineering Costs

• review plans with Department of Commerce
• review plans with hospital staff
• certify plans and calculations for State of
  Wisconsin.
• miscellaneous, e.g. mileage, copies, etc.

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Step Six Initial Assessment by Well Driller

• Driller must obtain approval from DNR
• Driller should have experience with wells of this
  size and scope
• Drilling methods and well design are identified
• Site for connecting to hospital is identified
  (site cannot be on a flood plain)

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Step Six Initial Assessment by Well Driller

• Determine well depth and aquifer to be used
  (driller has geological maps)
• Determine amount of gallons per minute that the
  well can produce (driller will know pressure
  levels from experience)
• Bacteria and nitrate tests nitrates should be
  lt10 PPM (driller may know this from experience
  with near-by wells)

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Westfields Driller Costs 9,825

• DNR Permit 75
• Drill Bit 500
• Drilling 6 3500
• Casings 6 1750
• Initial Drawings 350
• Water Testing 150
• Backhoe 500
• Directional Boring 3000
• optional site specific

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Step Seven Assessment by Master Plumber

• Comply with all Department of Commerce
  regulations
• Back-flow preventer is required
• Ability to easily switch to well as source of
  water
• need to estimate the time for the switchover so
  that affected hospital services can plan
  accordingly

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Westfields Plumbing Costs 14,000

• 65 gpm Pump 9500
• RPZ Valve 1000
• back-flow preventer
• 2 Building Piping 2500
• Chlorine Injection Pump 1000

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Step Eight Assessment of Electrician

• The facility needs to determine the amps
  available through the electrical generator
• If sufficient amps are not available for well
  pumps, then
• hospital needs to prioritize areas/functions that
  may need to come off emergency electrical power
• add capacity to the generator (more expensive
  option)

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Westfields Electrical Costs 8,009

• Electrical Connections 7509
• Other Wiring 500

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Project Cost

• Westfields Hospitals total cost was 41,629
• Hospitals may find that costs may vary due to
• Well location
• Well driller (bids)
• The need for directional boring
• Electrical charges
• Engineering charges

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Project Recommendations

• Plant Operations should hold meeting with all
  contractors
• Notify staff and patients of times of noise and
  vibration
• water supply will be disrupted when hospital
  plumbing is first connected to the well
• Notify helicopter services of obstruction by
  drill rig

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Maintenance

• Test and run well system at least twice a year
  for proper operation
• actual test of plumbing connections necessitates
  flushing system before return to local water
  utility source
• otherwise, well water can run into the drain
  without connecting to hospital water supply
• Well water sample must be tested once a year for
  Bacteria and Nitrate levels
• The facility must provide liquid chlorine for the
  injection system used

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Well Head(covered by attractive fake rock)
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Ready to Drill
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First Flow of Water (checking for rock content)
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Pressure Testing
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Back-Flow Preventer
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Letter of Thanks!

• Westfield's Hospital is very grateful to be one
  of the sites chosen for the emergency water well
  project. This emergency water well will allow
  Westfields Hospital to operate independently from
  the city of New Richmonds water utility system
  in the event of a water main break or
  contamination. This very pro-active mitigation
  measure assures the residents and city officials
  that Westfields Hospital will continue to serve
  as an operational emergency care facility during
  a possible water crisis.
• Jean Needham, President/CEO
• Richard A. Haider, Emergency Preparedness

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Contact Information

• Richard Haider
• Emergency Preparedness Coordinator
• Westfields Hospital
• New Richmond, Wisconsin
• 715-243-7629
• richard.a.haider_at_westfieldshospital.com
• Dennis Tomczyk
• Wisconsin Hospital Emergency Preparedness
• Madison, Wisconsin
• 608-266-3128
• dennnis.tomczyk_at_dhs.wisconsin.gov