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Welcome
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
Ice for Patient Care
• 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
Ice for Patient Care
• 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 for Patient Care
• 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)
Ice for Patient Care
• 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
Ice for Patient Care
• 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
Ice for Patient Care
• 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
Ice for Patient Care
• 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
Ice for Patient Care
• 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
Ice for Patient Care
• 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
Ice for Patient Care
• 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
Water Treatment Options
• 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
Water Treatment Options
• 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
Water Treatment Options
Water Treatment Options
Crude Filtration:
Has some capability to
remove particles of the
pore size quoted
Water Treatment Options
Nominal Filtration:
Removes typically 50-
90% of particles of a
given size
Water Treatment Options
Absolute Filtration:
Removes typically
99.98% of a defined
particle of a given
size
Water Treatment Options
Microbial Filtration:
Reduction of an organism
(typically 6-7 log) and accounts
for the morphology of bacteria
Water Treatment Options
Sterilizing Grade Filtration:
Similar to microbial, but with
zero challenge bacteria
recovered
Pore size is not necessarily
correlated to filter performance!
Water Treatment Options
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).
Sterilizing Grade Filtration:
Water Treatment Options
This is a legally binding performance claim
Ask for the validation guide confirming this level of
performance
Sterilizing Grade Filtration:
Water Treatment Options
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
Water Treatment Options
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
Water Treatment Options
• 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
Water Treatment Options
• 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
Water Treatment Options
Water Treatment Options
• 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
Water Treatment Options
• 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
and related components
• Sanitizing the ice dispenser
and related components
• 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
Sanitizing High Pressure Water Lines
• 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%
Sanitizing High Pressure Water Lines
• 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
Sanitizing High Pressure Water Lines
• 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
Sanitizing High Pressure Water Lines
• 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
Semi-Annual Cleaning
• 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
Semi-Annual Cleaning
• 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
Semi-Annual Cleaning
• 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
Ice for Patient Care
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
Unsanitary Staff Practices
• 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
Unsanitary Staff Practices
• Scooping ice from the
storage hopper virtually
assures contamination
of the ice
• The dispensers must
be used in accordance
with their intended
purpose
Unsanitary Staff Practices
• 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?