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Public Health Guidance in Specific Settings During Drinking Water Advisories

ODH offers public health guidance for specific settings after a community and/or its public water system issues a drinking water advisory when microcystin resulting from a harmful algal bloom has been detected in finished drinking water at higher than 0.3 and 1.6 micrograms/liter (µg/L) over a period of time.  For information about any current drinking water advisory, go to ohioalgaeinfo.com.

  • Ambulatory Surgical Facilities
  • Birthing Centers
  • Campgrounds/Resident Camps
  • Daycare/Day Camp/Preschool Facilities
  • Dental Offices/Clinics
  • Dialysis Centers
  • In-Home Dialysis
  • Fire Departments
  • Food and Beverage Manufacturing
  • Food Service Operations
  • Retail Food Establishments
  • Home Health
  • Hospice
  • Hospitals
  • Nuclear Power Stations
  • Office Buildings
  • Pet Stores
  • Pools/Waterparks/Spas
  • Private Homes
  • Private Water Systems
  • Residential Care/Assisted Living Facilities
  • Skilled Nursing Facilities/Long-Term Care Facilities
  • Schools and Universities
  • Women, Infant and Children Program
  • Ambulatory Surgical Facilities

    At both advisory levels (0.3 and 1.6 µg/L), ambulatory surgical facilities should not use tap water for patient care that includes washing open wounds or exposed tissues unless the water has been treated at the facility to remove toxins.  Ambulatory surgical facilities that pre-treat water from the local public water supply using reverse osmosis, nanofiltration or continuous disinfection with chlorine as per recommended treatment specifications may continue to use the water for patient care.  

    Regular testing of the treated water for mycrocystin is required to ensure toxin removal.   Ambulatory surgical facilities without appropriate water treatment should reschedule elective surgeries when possible. 

    Birthing Centers

    At both advisory levels (0.3 and 1.6 µg/L), birthing centers should not use tap water for patient care that includes washing open wounds or exposed tissues unless the water has been treated at the facility to remove toxins.  Birthing centers that pre-treat water from the local public water supply using reverse osmosis, nanofiltration or continuous disinfection with chlorine as per recommended treatment specifications may continue to use the water for patient care.   Regular testing of the treated water for mycrocystin is required to ensure toxin removal.  

    Campgrounds/Resident Camps

    Campgrounds and residential camps should follow the drinking water advisory issued by the local community and/or public water system. Check their website or ohioalgaeinfo.com for information.

    Tap water may be safely used for cleaning surfaces in facilities.

    Also follow any public health advisory for recreational waters if issued by the Ohio Department of Health.

    Daycare/Day Camp/Preschool Facilities

    Daycare, day camp and preschool facilities should follow the drinking water advisory issued by the local community and/or public water system.  Check their website or ohioalgaeinfo.com for information.

    As a precaution, surfaces that children may put their mouths on, such as toys and teethers, should be rinsed with an alternative water source such as bottled water. Tap water may be safely used for cleaning surfaces that children will not put their mouths on.

    Dental Offices/Clinics

    At both advisory levels (0.3 and 1.6 µg/L), dental offices and clinics should not administer water to patients through the dental unit, ultrasonic scaler, or other dental equipment that uses the local public water system. This restriction does not apply if the water source is isolated from the local public water system (e.g., a separate water reservoir or other water treatment device approved to remove algal toxins).

    Patients should rinse with bottled or distilled water until the drinking water advisory has been cancelled. 

    During these advisory periods, tap water should not be used to dilute germicides or for hand hygiene.  For hand hygiene, antimicrobial products that do not require water (e.g., alcohol-based hand rubs) can be used.  If hands are visibly contaminated, bottled water and soap should be used for hand washing; if bottled water is not immediately available, an antiseptic towelette should be used.

    Tap water may be safely used for cleaning surfaces in the dental office/clinic. 

    Dialysis Centers

    At both advisory levels (0.3 and 1.6 µg/L), dialysis centers should not use tap water in dialysis units. Dialysis units that pre-treat water from the public water supply to ANSI/AAMI 26722, ANSI/AAMI 13959, ANSII/AAMI 11663 and ANSI/AAMI 23500  standards using reverse osmosis or nanofiltration or continuous disinfection with chlorine (specify types and CT values) may continue to use the water for dialysis. 

    Dialysis centers may consider using pre-packaged dialysate throughout the duration of a drinking water advisory.   All dialysate water, except for pre-packaged dialysate, must be frequently tested after treatment to ensure the efficacy of the treatment unit prior to use.

    In-Home Dialysis

    At both advisory levels (0.3 and 1.6 µg/L), in -home dialysis units should not use tap water in dialysis units. Dialysis units that pre-treat water from the public water supply to ANSI/AAMI 26722. ANSI/AAMI 13959, ANSII/AAMI 11663 and ANSI/AAMI 23500  standards using reverse osmosis or nanofiltration or continuous disinfection with chlorine (specify types and CT values) may continue to use the water for dialysis.  In-home dialysis users may consider using pre-packaged dialysate throughout the duration of a drinking water advisory.   All dialysate water, except for pre-packaged dialysate, must be frequently tested after treatment to ensure the efficacy of the treatment unit prior to use.

    Fire Departments

    During a drinking water advisory issued by a public water system, exposure to aerosolized microcystin toxins may occur during spraying of water for fire suppression.  Firefighters should consider wearing personal protective equipment to prevent the inhalation of aerosolized water during fire suppression activities.  

    Water used for fire suppression from surface water sources containing an active algal bloom are at increased exposure risk and should wear personal protective equipment to prevent the inhalation of aerosolized water during fire suppression activities.

    Food and Beverage Manufacturing

    • Ice – Follow the drinking water advisory issued by the local community and/or public water system. Check their website or ohioalgaeinfo.com for information.
    • Bottling/Canning – Follow the drinking water advisory issued by the local community and/or public water system. Check their website or ohioalgaeinfo.com for information.
    • Microbreweries – Follow the drinking water advisory issued by the local community and/or public water system. Check their website or ohioalgaeinfo.com for information.

    Food Service Operations

    • Ice Machines and Bulk Water Machines – Follow the drinking water advisory issued by the local community and/or public water system. Check their website or ohioalgaeinfo.com for information.
    • Dishwashing/Equipment – Food service operations may wash dishes with tap water when a final chlorine rinse is used that meets Ohio Food Code specifications for manual and mechanical ware washing equipment.  If chlorine sanitizer is not used, cleaned dishes may be rinsed with an alternative water source (e.g., bottled water) to remove any residue that might contain minute levels of microcystin.  Use of a post sanitizing rinse with tap water is not recommended.
    • Cleaning Surfaces – Tap water may be safely used for cleaning surfaces that will not come into contact with food.

    Retail Food Establishments

    At both advisory levels (0.3 and 1.6 µg/L), retail food establishments should not mist produce with tap water; use an alternate water source instead.  Also rinse vegetables with an alternative water source.  Do not use tap water for filling or topping off fish/crustacean tanks.  Tap water may be safely used for cleaning surfaces that will not come into contact with food.

    Home Health

    At both advisory levels (0.3 and 1.6 µg/L), tap water should not be used for washing or cleaning exposed tissue or wounds in the home health setting. Follow the drinking water advisory issued by the local community and/or public water system. Check their website or ohioalgaeinfo.com for information.

    Hospice

    At both advisory levels (0.3 and 1.6 µg/L), tap water should not be used for washing or cleaning exposed tissue or wounds in the hospice setting. Follow the drinking water advisory issued by the local community and/or public water system. Check their website or ohioalgaeinfo.com for information.

    Hospitals

    At both drinking water advisory levels (0.3 and 1.6 µg/L), hospitals should not use tap water for patient care that includes washing open wounds or exposed tissues unless the water has been treated at the facility to remove toxins.  Hospitals that pre-treat water from the local public water supply using reverse osmosis, nanofiltration or continuous disinfection with chlorine as per recommended treatment specifications may continue to use the water for patient care.  

    Regular testing of the treated water for mycrocystin is required to ensure toxin removal.   Hospitals without appropriate water treatment should reschedule elective surgeries when possible.

    • Sterilization – Clean steam autoclaves with reverse osmosis treatment are acceptable for use.  Steam autoclaves should not use tap water for generating steam.
    • Wound Care – Tap water should not be used for washing or cleaning exposed tissue or wounds.
    • Skin Conditions (e.g., eczema) – Skin irritation, such as a rash, may occur from exposure when bathing and washing hands.  Providing a final rinse of skin with uncontaminated water is recommended.

    Nuclear Power Stations

    At both drinking water advisory levels (0.3 and 1.6 µg/L), nuclear power plants may safely continue to use water per normal procedures. Microcystin toxins do not evaporate from water, so there is no risk from steam.

    Office Buildings

    Office building should follow the drinking water advisory issued by the local community and/or public water system. Check their website or ohioalgaeinfo.com for information.

    Tap water may be safely used for cleaning surfaces in the building.

    Pet Stores

    At both drinking water advisory levels (0.3 and 1.6 µg/L), pet stores should not use tap water as drinking water for animals.  Do not bathe animals using tap water as they will lick and groom themselves after bathing.  Do not use tap water for filling or topping off fish/crustacean tanks.

    Pools/Waterparks/Spas

    At both drinking water advisory levels (0.3 and 1.6 µg/L), swimming pools, waterpark and spa features that use tap water should super-chlorinate the facility using standard procedures. 

    Follow any public health advisory for recreational waters if issued by the Ohio Department of Health.

    Private Homes

    • Hand Washing – Guidance depends upon the drinking water advisory level.  Follow the advisory issued by the local community and/or public water system. Check their website or ohioalgaeinfo.com for information.
    • Brushing Teeth – Guidance depends upon the drinking water advisory level.  Follow the advisory issued by the local community and/or public water system. Check their website or ohioalgaeinfo.com for information.
    • Showering/Bathing – Guidance depends upon the drinking water advisory level.  Follow the advisory issued by the local community and/or public water system. Check their website or ohioalgaeinfo.com for information.
    • Cooking – Guidance depends upon the drinking water advisory level.  Follow the advisory issued by the local community and/or public water system. Check their website or ohioalgaeinfo.com for information.
    • Dishwashing – Dishes may be washed with tap water.  After washing, dishes may be rinsed with an alternative water source such as bottled water to remove any residue that might contain minute levels of microcystin. 
    • Cleaning Surfaces – As a precaution, surfaces that children may put their mouths on, such as toys and teethers, should be rinsed with an alternative water source such as bottled water.
    • Laundering Clothes – Clothing may be laundered safely with tap water. 
    • In-Home Nebulizer/CPAP/BiPAP – In-home nebulizers or CPAP/BiPAP components should not be washed with tap water; use an alternative water source instead such as bottled water.
    • Lawn and Recreational Water Exposure – Closely observe and monitor children playing in lawn recreation devices such as sprinklers to prevent ingestion of the contaminated water.
    • Point-of-Use Water Filtering Devices – Point-of-use water filtering devices such as pitchers with filters and countertop or under-sink mounted treatment units have not been evaluated by  independent testing agencies such as NSF International or the Underwriters Laboratory (UL) for their ability to remove algal toxins from drinking water.  There is no guarantee these products will effectively remove algal toxins.  Consumers should carefully review any product removal claims to ensure the product has been tested by a reputable third party testing agency prior to use.  According to NSF International, it will be testing and certifying point-of-use products for removal of microcystin by late 2015. 
    • Personal Water Containers – Containers individuals bring from home to transport water from a water distribution facility during a drinking water advisory should be marked or rated as safe for contact with drinkable water.  Containers used to store food or beverages are considered safe for contact with drinkable water.  Milk jugs or juice bottles may be used to transport water if they are thoroughly washed, rinsed and sanitized.  Utility buckets and similar containers are not considered safe for contact with drinkable water and may release other undesirable chemicals into the stored water.  Please remember that water weighs 9.3 pounds per gallon; be sure to determine how much water can be carried or transported safely in a container.
    • Flushing of Residential Water Lines – Homeowners should follow the recommendations for flushing water lines and replacement of water filter devices for appliances or point-of-use treatment systems after a drinking water advisory is lifted. 

    Private Water System

    During a drinking water advisory, follow private water system recommendations for the treatment of ponds or groundwater systems, such as spring and water well systems.

    Residential Care/Assisted Living Facilities

    Residential care and assisted living facilities should follow the drinking water advisory issued by the local community and/or public water system. Check their website or ohioalgaeinfo.com for information.

    Skilled Nursing/Long-Term Care Facilities

    At both drinking water advisory levels (0.3 and 1.6 µg/L), skilled nursing facilities should not use tap water for patient care that includes washing open wounds or exposed tissues unless the water has been treated at the facility to remove toxins. 

    Facilities that pre-treat water from the local public water supply using reverse osmosis, nanofiltration or continuous disinfection with chlorine as per recommended treatment specifications may continue to use the water for patient care.  

    Facilities should follow the drinking water advisory issued by the local community and/or public water system. Check their website or ohioalgaeinfo.com for information.

    Schools and Universities

    Schools and universities should follow the drinking water advisory issued by the local community and/or public water system. Check their website or ohioalgaeinfo.com for information.

    Also follow any public health advisory for recreational waters if issued by the Ohio Department of Health.  Tap water may be safely used for cleaning surfaces in facilities.

    Women, Infant and Children (WIC) Program Recipients

    WIC participants should follow the drinking water advisory issued by the local community and/or public water system. Check their website or ohioalgaeinfo.com for information.

    WIC participants may go to their local WIC Clinic on the next business day to have any remaining formula benefits for the current month changed to ready-to-feed formula.  Formula changes will be for the current month only.  Should the drinking water advisory continue into a new month, formula benefit changes must be pursued again.

    Please contact the Bureau of Environmental Health and Radiation Protection, Residential Water and Sewage Program at (614) 644-7558 for questions or additional information. 

     

    Page Reviewed: 11/24/2015