Best Practices for Ice Makers and Dispensers in Patient ... · manufacturer •Filter membrane...

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Best Practices for Ice

Makers and Dispensers

in Patient Care Settings

© 2018 Follett LLC

Agion is a registered trademark of Sciessent LLC.

Symphony is a trademark of Follett LLC.

Follett is a registered trademark of Follett LLC, registered in the US.

5/10/19

Ice for Patient Care

• Ice dispensers are

getting increasing

scrutiny today


• All materials that touch

the ice and water are

NSF® approved for

contact with food

• The ice dispenser

does not create

microbial growth

• The original source is

outside the dispenser

• The goal is to minimize

contamination risk


• If bacteria is present in the

water it can grow over time

• Microbes are present in all

water supply systems

• They attach to the inside of

water supply systems

• Once attached they create

biofilm for protection

• When water systems sustain

shocks the biofilm can

become dislodged


• Ice is frozen water

• Ice and water dispenser

manufacturers all presume

potable water

• Conventional water filter

manufacturers all presume

potable water

• Potable water is defined by

the US EPA Safe Water

Drinking Act (SWDA)


• If bacteria is present in the

water it can grow over time

• Icemaker and water filter

manufacturers are adding

antimicrobial materials to their

products

• Important: this inhibits growth

only on the treated parts


• Antimicrobial materials do not

treat the ice or water

• Antimicrobial materials do not

kill microbes or bacteria

• When microbes come in

contact with a surface treated

with antimicrobial material it

renders microbes unable to

reproduce


• More incidents of contaminated

building water supplies are

occurring

• If you have a known problem

with a waterborne pathogen, a

waterborne pathogen expert

should be consulted to help with

sanitizing

• The entire water system must

be treated


• Disinfection of water systems to remove pathogens

is very difficult

• In a drinking water installation, thermal or chemical

disinfection would be used to minimize harmful

microorganisms

• Pathogens can survive disinfection and regrow


• The potential enemies of your icemaker and dispenser

are:

• Suspended solids in the water – sediment

• Dissolved solids in the water – liquid rock

• Waterborne parasites, microbes and bacteria

• Improperly done preventive maintenance

• Improper installations

• Airborne microbes and bacteria

• Unsanitary staff practices


• Suspended solids in the water – sediment

• Addressed by water treatment

• Dissolved solids in the water – liquid rock

• Addressed by water treatment and proper

maintenance performed on a timely basis

• Waterborne microbes and bacteria

• Addressed by water treatment and proper

maintenance performed on a timely basis


• No filtration

• Success depends on:

• Level of suspended solids – can leave

sediment

• Level of dissolved solids – can interfere

with mechanical operation

• Level of chlorination – gives an off taste

to ice and water

Water Treatment Options

• Conventional carbon filtration

• Removes the chlorine for fresher tasting

ice and water – encourages desirable and

necessary patient hydration

• Traps suspended solids – reduces

sedimentation and may trap waterborne

parasites

• Usually treats water to inhibit scale buildup

• May contain antimicrobial material


• Conventional carbonless filtration

• Leaves the chlorine in the water to inhibit

microbial growth – may result in unpleasant

tasting ice and water

• Traps suspended solids – reduces

sedimentation and may trap waterborne

parasites

• Usually treats water to inhibit scale buildup

• Usually does not contain antimicrobial

material because disinfectants remain in

the water


• Microbiological filtration

• Filtering to 0.5 microns or less is

required to capture waterborne

parasites such as cysts and

cryptosporidium

• Microbial filters of 0.2 microns or less

are required to capture Legionella and

other waterborne pathogens



Crude Filtration:

Has some capability to

remove particles of the

pore size quoted


Nominal Filtration:

Removes typically 50-

90% of particles of a

given size


Absolute Filtration:

Removes typically

99.98% of a defined

particle of a given

size


Microbial Filtration:

Reduction of an organism

(typically 6-7 log) and accounts

for the morphology of bacteria


Sterilizing Grade Filtration:

Similar to microbial, but with

zero challenge bacteria

recovered

Pore size is not necessarily

correlated to filter performance!


Complete retention of a defined microorganism

(typically Brevundimonas diminuta) at a challenge

concentration of > 107 colony forming units per

cm2 of effective filtration area per ASTM F838

under representative processing conditions (HIMA

1982 and PDA/FDA 1995).



This is a legally binding performance claim

Ask for the validation guide confirming this level of

performance



Icemaker manufacturers validate

water filters for:

• Efficacy

• Material compatibility with

sanitizers specified by the

manufacturer

• Filter membrane mechanical

compatibility with intermittent

use – solenoid valve cycling

limits

• Ask for the filter life field study

and validation guide


What to look for?

• Sterilizing grade means all

challenge bacteria is removed

• Avoid filters with cycling limits

unless there is a way to

validate the cycles from all

solenoid valves

• Is the filter compatible with all

sanitizers and surface

disinfectants likely to be used?

• Ask for the field study and

validation guide

Be sure to:

• Follow manufacturer’s

instructions – replace

cartridges at prescribed

intervals

• Use proper replacement

cartridges:

• 10 micron prefilter

• 1 micron absolute prefilter

• Do not bypass essential

protection components

• 50 psi regulator


• Emerging technologies

• Ultraviolet light

• Actively kills microbes – disrupts cells

• Line of sight technology

• Only sanitizes where the light can reach

• Does not produce any off tastes in the

ice or water


• Emerging technologies

• Ozone generation

• Actively kills microbes by oxidation

• Not restricted by line of sight

• Can penetrate through ice stored in a

hopper

• Produces an off taste in water if

overdosed



• Regardless of the strategy

you choose…

• Water filter cartridges must

be replaced at the interval

recommended by the

manufacturer

• Earlier replacement may be

required due to insufficient

flow rate


• No matter how effective the

water treatment is…

• Ice-making and ice dispensing

equipment must be maintained:

• At regular prescribed

intervals

• Using approved materials

• In compliance with the

manufacturer’s

instructions

Preventive Maintenance

• Generally, the process will be:

• Cleaning and descaling the

evaporator

• Sanitizing the evaporator

and related components

• Cleaning the ice dispenser


• Sanitizing the ice dispenser


• Most ice machine cleaners

contain citric or phosphoric acid,

which can cause skin irritation.

Read caution labels on the

product and follow instructions

carefully.

• Wear rubber gloves and safety

goggles (and/or face shield)

when handling ice machine

cleaner or sanitizer.

Preventive Maintenance

Sanitizing High Pressure Water Lines

• Not required by NSF but is

recommended for best practice

• Treats the system starting at

the water filter

• Treats the water line and

components of the water

dispense station

• Especially important if water

filters containing carbon for

chlorine removal are being

used


• Use a procedure that has

been tested by NSF and

verified to meet the same level

of efficacy required by NSF

Standard 12 on icemakers

• Six log reduction – removes

99.9999%


• This procedure must be done

before the icemaker is cleaned

and sanitized – always work in

the direction of the water flow

• Treats both the icemaking and

water dispense systems

• If a harmful waterborne

pathogen is detected consult

with a pathogen expert for

guidance


• The kits typically have parts

for temporarily bypassing in-

line water filters prior to

replacement

• Intended to be mounted on a

service cart – movable from

unit to unit

• Connects to the water tap

valve or water line

• Canister is filled with the

sanitizing solution


• Kits intended for head-

style water filters include

parts needed for

bypassing filters

removed for replacement

• The pre-filter canister is

filled with the sanitizing

solution

Mineral Effects on Sanitizing

• Auger removes ice from the

evaporator wall

• As water freezes, dissolved

minerals separate from water

• Minerals form scale on the

evaporator and related components

• Scale increases loads and reduces

effectiveness of the sanitizing

procedure

• Icemaker evaporator cleaning

solution dissolves the mineral

buildup

Semi-Annual Cleaning

• Use materials approved

by the manufacturer

• Mix the cleaning and

descaling solution

according to the

manufacturer’s

instructions

• A warm solution is more

effective than a cold one

• Do not use boiling water

+

100°F


• Before adding the

cleaning solution ensure

that the evaporator is

completely free of ice

• Ice will displace the

cleaning solution

rendering the procedure

ineffective

• Ideally the evaporator

should be room

temperature


• Procedures vary

by manufacturer

• When cleaning

and descaling, run

the compressor or

not as directed

• Do not assume

that procedures

called for on one

brand will work on

another


• As icemaker evaporator

cleaning solution

dissolves mineral

buildup…

• The acid becomes

neutralized

• A second application

may be required for

complete buildup

removal

Sanitizing

• NSF Standard 12

includes a test of the

manufacturers cleaning

and sanitizing

procedure

• The NSF logo means

that the sanitizing

procedure has been

tested by and has met

or exceeded the

requirements of the test

Sanitizing

• The test is done using the

sanitizer specified by the

manufacturer

• In the concentration specified

by the manufacturer

• At the solution temperature

specified by the manufacturer

• Following the manufacturer’s

instructions

Sanitizing

• Additional steps may be

called for:

• Cleaning the top of the

float

• Removing scale in the

upper section of the

reservoir resulting from

spray due to high water

inlet pressures

Sanitizing

• Cleaning the drain cup

and drain line

• Removing and cleaning

the water feed lines with

an appropriately sized

bottle brush

• Having spare, clean parts

available (to swap and

clean for re-use later) can

streamline the procedure

Sanitizing

• However – all of these

activities must be done

prior to beginning the

tested and approved

sanitizing procedure

• Once the procedure is

started, it must be done

exactly according to the

manufacturer’s procedure

as tested and approved

by NSF

Sanitizing

• On SymphonyTM

dispensers the

compressor is run with

sanitizer in the water

system

• This must be done with the

200 ppm quaternary

ammonium solution at

120°F

• This must be done for 20

minutes

Sanitizing

• All sanitizer concentration

instructions must be

followed

• All sanitizer temperature

requirements must be

followed

• All sanitizer application

time requirements must be

followed

• Follow the approved

procedure

Sanitizing

• All ice must be removed

from the ice storage hopper

• None must be put back into

the hopper when the

procedure is complete

• Ice agitation components

must be removed for

cleaning per the

manufacturer’s instructions

Sanitizing

• Spraying sanitizing

solution on the surfaces

or pouring the solution

under the dispense wheel

is ineffective

• To break up the bio-film

the parts must be wiped

down with a clean soft

cloth soaked in the

cleaning and sanitizing

solutions

• No abrasive materials

should be used

Sanitizing

• The drain lines should be

cleaned with an

appropriately sized bottle

brush using the cleaning

and sanitizing solutions

Sanitizing

• Some cleaning and/or

sanitizing solutions do not

require rinsing

• Some solutions do

require rinsing

• Be sure to follow the

manufacturer’s

instructions

• Other potential enemies of your icemaker and

dispenser are:

• Outside contractors

• Trained on manufacturer’s approved

procedures?

• Following manufacturer’s approved

procedures?

• Deficient installations

• Improperly run drain lines

• Lack of cleaning access

• Dead legs in the water supply line


Installations

• Drain lines must

not be in direct

contact with sink

or wall drains

• Contact can

allow bacteria to

migrate up the

drain line to the

dispenser

Installations

• An air gap between the

dispenser drain line and

the wall drain is required

• A trap will be required if

the dispenser drain is

connected downstream of

the sink trap

Installations

• Clear vinyl tubing is a

poor choice for drain

line material

• Rigid tubing – copper

or PVC should be used

• Drain lines should not

be run flat – should be

pitched at least 1/4"

per foot of run

• Insulation may be

needed

Installations

• Installing dispensers

on legs is highly

recommended

• Permits cleaning

under the dispenser

• Allows the unit to be

leveled – eliminating

the potential for low

spots in the water

system and ice

storage hopper

Installations

• Ice storage capacity

must be properly

sized to match the

anticipated patient

load

• Oversized storage

bins reduce rotation

of the patient ice

• Reduces ice

freshness, and

degradation can

lead to jamming

Installations

• With complex water

systems, dead legs

are common in

hospitals

• Can provide a

location for

microbial growth

• Dead legs can

sometimes be found

in the equipmentDrain Clamp

P/N 00988238

Introduced

January of 2012

Unsanitary Staff Practices

• All air cooled dispensers

have an air intake

• Powders from drink mixes

(nutrients) can be drawn

into the unit when prepared

near the intake

• Organic material from

substances such as

ground coffee and flour

can be drawn into the unit


• Dispensing ice into cups

already containing

beverages results in

splashing

• Beverages other than

water contain organic

compounds and/or sugar

• Retrograde contamination

in the dispense chute

area is the result


• Scooping ice from the

storage hopper virtually

assures contamination

of the ice

• The dispensers must

be used in accordance

with their intended

purpose


• The ice storage hopper

is intended to store ice

ready for dispensing

• Lunch bags, yogurt

containers, water

bottles, cans of soda,

and the like should

never be stored in the

hopper with the ice!

Key Points

• Use microbial filters to prevent the introduction of

waterborne bacteria

• Sanitize the equipment at the interval prescribed

by the manufacturer

• Be alert to conditions that may require more

frequent sanitizing

• Ensure the NSF approved sanitizing procedure is

being followed

• Be alert to unsanitary staff practices

Questions and

Answers

Questions and discussion?

Date post:	16-Aug-2020
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