How Do You Run a Hospital With No
Running Water?

Diana Swift

February 22, 2021

It's bad enough that this month's historic snowstorm left ordinary Texans scrambling for heat and resorting to melted snow for drinking, washing, and flushing. But what about hospitals, where sanitation is paramount and ample water is a sine qua non?

As pipes burst, pumps froze, and water pressure plummeted, patient care was affected as well as maintenance, food preparation, laundry, and heat. To counter the problems, several Texas hospitals stepped up to the plate with inventive responses.

In Houston, Texas's largest city and no stranger to natural disasters from hurricanes Ike to Harvey, water pressure in the municipal supply system dropped after the February 13 storm, creating a series of problems for some of Houston Methodist's eight-hospital network. "At the worst point, two of our hospitals, Houston Methodist West and Houston Methodist Baytown, had no city water supply, one for over 48 hours and the other for 72 hours," said
Marc L. Boom, MD, MBA, Houston Methodist's president and CEO.

Although the main hospital had a reserve supply of potable water, a supply of water for laundry, cooking, and cleaning was another matter. "We introduced significant water restrictions and had to have 6000-gallon tankers bring in extra water," Boom said.

One hospital in the network got creative. When it rained the day after the ice storm, the staff rigged up a rain collection system using the huge bins that move linens around the hospital to collect non-potable water for cleaning and flushing toilets, Boom said. Another hospital was able to provide showers for staff by bringing in bathroom trailers with self-contained water supplies of the kind used at some sporting events.

And at some facilities, patients were discharged into the lobby as they could not return  home with transportation, electricity, and water systems crippled. With widespread challenges continuing, even as temperatures warmed, President Biden signed a major disaster declaration on Saturday that will provide emergency assistance to residents and businesses in more than a third of Texas counties, including those surrounding Houston, Dallas, and Austin.

Although conditions forced the rescheduling of some nonemergent surgeries, the water shortage had no impact on COVID-19 care, except for the unavailability of showers in the case of mobile patients. "At the worst, they just had to use bucket flushing for the toilets," Boom said.

And in an unexpected win, when a Harris County freezer for COVID-19 vaccine storage failed and threatened to spoil 8400 precious doses, Boom's center was able to take delivery on 1000 doses and administer them in three hours at a hastily set up ad-hoc immunization center. 

In all this, the lessons of the pandemic had a positive preparatory role. "2020 taught us to be agile as things change and to align our goals across different medical teams," said Ben Saldana, MD, medical director of Houston Methodist's emergency care centers. "And we were prepared for hurricanes, but not for snow."

Increased Pressure on Emergency Departments

As the outages continued and stress levels in the community rose, the network started seeing exacerbations of chronic conditions after the power shut-down incapacitated electrical devices running machines for heart assistance, oxygen delivery, and sleep apnea. "We started seeing food-borne illness and carbon monoxide poisoning, as well as more heart attacks, strokes, and sepsis," Saldana said.

One serious strain on the network's main hospital was the sudden need to accommodate large numbers of patients on dialysis, a procedure that uses a lot of water and is typically performed in small, vulnerable community facilities with limited infrastructure and no generators. "The hospitals are their backup and act as a safety net for them," Boom said. Some hospital areas generally used for other types of conditions had to be marshalled for renal care.

Emergency rooms became pop-up dialysis centers, Saldana said. "And if the water pressure dropped, we had to cut dialysis time from the standard 4 hours to 2. That's like putting a Band-Aid on patients."

Fortunately, municipal water pressure in the Houston area has steadily risen and is almost back to normal. And according to Boom, the brutal storm may yet have a silver lining: a decline in County coronavirus cases as the storm and icy road conditions forced people to stay sequestered at home.

Further north in Austin, a number of hospitals lost municipal water pressure, creating a series of problems. Among them was St. David's South Austin Medical Center, at which, according to reports in the Austin American-Statesman, staff members were at one point asked to use trash bags to remove waste from toilets, to refrain from showering, and to clean their hands only with sanitizer.

A statement issued by David Huffstutler, CEO of St. David's HealthCare, acknowledged that the heating system is based on a water-fed boiler. When the building lost heat owing to lack of water, some patients had to be transferred elsewhere or discharged. The hospital distributed jugs and bottles of water for handwashing and drinking, and was working with city officials to obtain portable toilets.

Meanwhile, officials at Austin's Dell Children's Medical Center acknowledged in a memo that its toilets no longer had "flushing capabilities." Other area hospitals in the Ascension Seton network were also suffering from compromised water supplies last week, according to local news reports.

Washroom facilities were affected elsewhere as well. A post on a medical association Facebook page referred to a memo ordering staff to use a single toilet in an outpatient area for bowel movements and warned them to limit their time there. No paper or other products were to be used in other toilets designated for urination.

"The Pandemic Was the Prelude to the Ice Storm"

Some hospitals fared better. Along the Coastal Bend, Corpus Christi Medical Center managed to maintain its electricity and water supply to ensure continuity of hospital services after the storm, according to a statement sent to Medscape Medical News.

But back in Houston, Liz Youngblood, MBA, RN, president of Baylor St. Luke's Medical Center, said a number of hospitals in her network experienced low water pressure after the storm.

"Fortunately, we had water conservation measures and low-water alerts in place for such emergencies," she said. "And we rely on water tankers to help maintain enough pressure for the basics."

Some of the challenges posed by the storm are quite similar to what St. Luke's faced after Hurricane Harvey in 2017. "We had already made plans to address them and so we felt prepared," Youngblood said.

And thanks to COVID-19, Texas hospitals have been operating in crisis mode for the past year. "The pandemic was the prelude to the ice storm," said Gina Blocker, MD, a St. Luke's emergency room physician, "so we had measures and teams in place. We did have some reduction in water pressure, though the pressure was still good."

But the hospital was inundated with patients looking for shelter. "Some were just scared about what might happen to them if their heat didn't come back on and they wanted to be where they could get care," Blocker said. Others came in with expected storm-related injuries such as hypothermia and carbon monoxide poisoning.

According to Youngblood, little compromise in patient care was necessary except for the cancellation of some operations and vaccinations owing to the treacherous travel conditions. "But one of the biggest remaining issues is that we need plenty of blood, so we're encouraging people to donate at their local centers."

Diana Swift is a medical journalist based in Toronto.

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