VERDA’s CEO, Jeff Paquet, joins the First Case Podcast, hosted by Melanie Perry and Justin Poulin, for an episode titled Beyond the Tap: Why Water Quality Is Critical to Surgical Safety to talk about why water quality isn’t just an engineering issue—it’s a surgical safety issue.
You’ll hear:
- Why water is often the hidden variable in reprocessing
- How AAMI ST108 is reshaping expectations
- What hospitals can do now to prepare and protect outcomes
From real-world risks to practical solutions, this episode dives into how VERDA helps eliminate water as a weak link in sterile processing. Here is the transcript:
Justin Poulin:
Today on First Case, we have a vendor spotlight with VERDA Water Quality Systems for you. We’ll be speaking with CEO, Jeffrey Paquet. He’s been on other podcasts in our family of podcasts, including Beyond Clean for Sterile Processing and Power Supply for the Health Care Supply Chain. But today, he joins us to talk about why you should care about water in your facilities, why you need a comprehensive water quality management program that’s developed, how it’s been very siloed in its management in the past, and a new guideline that we will link to the AORN guidelines as well. But this one’s AAMI ST108. You may not have heard of AAMI before, but you will definitely know them by the end of this interview, Melanie.
Melanie Perry:
You will, and you’ll actually be able to connect the dots between the big overview that we get with AORN guidelines when it comes to water quality, to be able to dive into the actual specifics and the prescriptive treatment and care that really water deserves and needs. I think, hopefully, you will walk away realizing that water is not water. There’s a lot more to it. There’s a lot of science that goes into it. The more we take care of our water and have good water for our instrument care and cleaning, ultimately, the better care we’re providing for our patients. Being able to connect those dots and see how water can affect patient safety and patient care is paramount to what we do in the operating room anyway. So great conversation we’re going to have today.
Justin Poulin:
Yeah, let’s jump right into it after a short break. We’ll be back with Jeffrey Paquet.
Today on the First Case podcast. We are speaking with Jeffrey Paquet, CEO at VERDA Water Quality Systems. We’re going to be talking about water quality and really not just in the operating room, but sterile processing and really the entire healthcare facility, Melanie, and really excited to have Jeffrey on. He’s been on the podcast before. He’s joined me on some of our sister podcast, Beyond Clean, and also Power Supply. Jeffrey, we’re really honored to have you here on the First Case podcast. Thanks so much for coming on.
Jeffrey Paquet:
Well, thank you very much. I’m really thrilled to be here, and I’m looking forward to talking to Melanie here.
Justin Poulin:
Well, Melanie is going to give you all the insights from inside the operating room during this conversation today, because it’s really a surgical safety issue. What you’re eliminating is water as a hidden risk factor in sterile processing and ultimately having an impact on surgical outcomes. I thought maybe you could just introduce us to VERDA Water Quality Systems, or maybe people out there that have not engaged with your company in the past, and maybe even tell us a little bit about your origin story.
Jeffrey Paquet:
Sure. Love to. So, VERDA Water Quality Systems was born out of a parent health care company, Mobile Medical International or MMIC. In 1994, we, MMIC, introduced the first licensable ambulatory surgery center to mobile ambulatory surgery center to the market, North American market. We are fundamentally an engineering and facilities company that understands the requirements of the OR and of hospitals. And so, our origin is in healthcare and understanding healthcare facilities. We eventually became involved in mobile sterile processing. As part of mobile sterile processing, we were having to provide treated water to process instruments in our units. That’s where we really discovered the problems that hospitals have with managing water in the SPD and what type of impact that can have on the OR and patient safety. Where most water quality providers or equipment providers and service providers come at this from a water treatment background, our origin story is really the surgical workflow, infection control, and sterile processing.
Justin Poulin:
I’ll tee this up a little bit, too. I feel like a lot of times, when instruments get to the OR and they’re staining, they’re spotting, there’s pitting on instruments. In my work with sterile processing in the operating room, a lot of times, the OR is just not really at all of what could be causing it. But then it creates some confusion when they’re inspecting the instruments, right, Melanie?
Melanie Perry:
Yeah, we just think it’s sterile processing fault. Wait a second. Is this safe to use?
Justin Poulin:
What are some common causes with that, Jeffrey? I feel like there’s a siloed approach to how this gets addressed, which is why there just continues to be confusion about what the underlying root causes might be.
Jeffrey Paquet:
Right. I mean, real briefly on a technical aspect, water is both our friend and our enemy, just like you can drink water and it’s good for you, or you can drown in it. It’s the same thing in health care. Water is the primary dissolver and sterilizer of many of our instruments when they’re being reprocessed. But the water that’s being provided municipality in general, and in many cases, does not meet the specs, the IFUs for the equipment that you’re using to process, nor the instruments that are being processed. Problems with instruments such as corrosion, pitting, staining, those type of things, can all be and have their origin as a result of water not being managed properly.
Justin Poulin:
There also wasn’t a lot of guidance, right? I mean, up until recently, it’s not very prescriptive about ways to have a very, I guess, sound water quality program or management program in the healthcare facilities. AAMI, which, Melanie, you can confirm, I’m not sure that the operating room, especially frontline techs and circulators, et cetera, might not even be aware of AAMI guidelines. In New Jersey, it’s actually law. A new standard came out, ANSI/AAMI ST108. Jeffrey, you and I have talked on other podcasts about this, but maybe you can provide an overview of ANSI/AAMI ST108. Then, Melanie, I think you’ll probably have a lot of follow-up questions because I don’t think this is a common topic in the operating room, but it’s definitely something to be keeping an eye on.
Jeffrey Paquet:
Right. Prior to August of 2023, when ANSI/AAMI ST108 was released, there had been another, what they call a technical information report in place. It was not a standard. It was an attempt to provide a lot of information about best practices for managing water and producing critical water in the SPD, which is what’s required for the IFUs for cleaning the and getting your equipment to work in there. However, it was not prescriptive. It had some prescriptive elements that says, “You should do this”, but most of it was, “Well, some people do this, some people do that”. “You can do this or that”. People have various opinions on that. Although I think hospitals tried to adhere to best practices, it was a pretty broad specification for what was best to do. Fast forward to ST108, and it’s a much tighter spec. It’s now a standard for AAMI. It is a lot more prescriptive of what you should do to maintain water quality in the sterile processing department.
Melanie Perry:
Okay, so I want to clarify something before we keep going, just because those of us in the OR, we understand the AORN guidelines. We’ve heard about the AST standards, the Association of Surgical Technology Standards. But these four letters, AAMI, are just probably something that is foreign to most people unless they’re in leadership and they’re also overseeing their sterile processing department. To come at it from a point of similar understanding, are we talking AAMI guidelines are what we would associate as maybe our AORN guidelines for surgical care. The AAMI guidelines are then those guidelines that are dictating best practice in sterile processing, right?
Jeffrey Paquet:
That is absolutely correct. Okay. Yeah, very similar.
Melanie Perry:
Okay. Just to make sure that we have leveled the playing field understanding that this is what we’re talking about, but guidelines that very much influence best practice and proper treatment and care of our instruments, obviously, also as we follow IFUs for different instruments. But when we talk about water, when we have a problem with our instruments in the operating room, our knee-jerk reaction isn’t, “Oh, the water must be a problem”. Our knee-jerk reaction is, “Oh, sterile processing screwed it up”. We just look at the people and think maybe it’s a people problem. But often it might not be a people problem It might be water. But until you have a conversation like this, you really just think water is water. What makes water so special in sterile processing that makes it so different from just our understanding of just water?
Jeffrey Paquet:
Right. A couple of things to address that. Number one is that, to get back to why ANSI/AMMI ST108 exists. It exists because, and your infection preventionists are going to understand this to some degree, is that water can be dangerous in hospitals. We worry about legionella, another type of aerosolized, airborne water-transmitted diseases, particularly for patients that have vulnerabilities. Water is used extensively for cleaning instruments, and in the sterile processing department, and then you are going to go put those instruments in your patient. So there can be a significant link between surgical site infections and waterborne problems that have come to you on the instruments. So water can actually act as a corrosive agent for your instruments if it’s specifications, if it’s not two-spec, and it can damage instruments. It can also reduce the efficacy of the cleaning chemicals that they’re using in the operating room. And what happens over time is the coatings on the instruments can become compromised. And what happens is a biofilm will begin to establish itself. It may be very microscopic, you can’t see it, but it’s a place where dead biological material is now hiding. And then that becomes a place where live biological material can hide from even steam sterilization.
Then you go and put that in your patient, and there’s going to be a transfer of those pathogens to your patient. That is something that is not always easily identified in sterile processing, even if they’re following all of their other IFUs, if the water is a problem. Because just like people in the operating room, the people in sterile processing are not experts in water chemistry and that type of thing. It’s difficult for them to control that problem without the right tools.
Melanie Perry:
Okay, so you’ve just, I don’t know, messed with my brain just a little bit because the understanding that if we don’t pre-treat our instruments, if we aren’t doing point-of-use cleaning, leaving blood, body fluids, all those things on our instruments can absolutely lead to biofilm. I jokingly refer to biofilm as the bacteria slime house that is growing on my instruments that I can’t see. I know that not treating my instruments can cause that. But I didn’t know that water could also be a problem and actually lead to biofilm. How does it do that?
Jeffrey Paquet:
Well, so as we discussed, it can create a problem with the instrument, begin to break the instrument down. And when the instrument breaks down, the surface that’s supposed to resist the deposit of biofilm is gone. And so then biofilm can begin to deposit itself on that. And so tap water, although safe to drink, does contain at least a lot of dead bacteria, if not some living bacteria, right? So if you’re going just to high level disinfection in something, it’s potentially there could still be some bacteria left around. The other thing is, and many people don’t realize this, probably, is the critical water, which is the deionized or RO water that you use to rinse the instruments clean. The first thing we do with that is we remove all the disinfectant before it’s used because it would cause problems with the process of purification. When that disinfectant is removed, there’s nothing to combat bacteria. In water within the matter of hours can become completely polluted with bacteria if bacteria isn’t being controlled and managed on a regular basis by the equipment that’s producing it.
Melanie Perry:
It’s very disturbing.
Jeffrey Paquet:
It is disturbing. And so you could be sending a bunch of bacteria on a clean instrument, even if it goes to sterilization, it’ll break down the bacteria, kill it. But then now you have endotoxins, and now you’re introducing those to your patient on the instruments.
Melanie Perry:
Okay, so then as we understand water, and you’re talking about different kinds of water, you said RO water? What is that?
Jeffrey Paquet:
So ultimately, when you produce critical water, what we’re trying to do is remove the ionic contaminants along with other types of contaminants, including microbes and other pathogens. To do that, it has to be either a chemical electrical process, like you would have in a deionization tank, where you’re exchanging ions, you’re basically removing ions from the water through an electrical charge process on some media. Or in reverse osmosis, you have very, very fine filters that actually are at the molecular level, can actually strain out those ions. And so both are deionization processes. Sometimes they’re used together, but they’re fundamentally just getting rid of things like metals, a lot of metals and other types of things that cause electrical charges. Electrical charged ions create corrosion. They begin to break down the instrument because they’re electrically charged. And over time, that causes problems of the instruments, biofilm, SSIs.
Melanie Perry:
As I’m just completely randomly picking your brain on all these things that I just have questions about, I have one more, and then I will stop hijacking this conversation. Oh, no.
Jeffrey Paquet:
It’s all about you.
Melanie Perry:
I’m assuming, and this is me making an assumption, that the water that you need in decontam is not the same water that you need in your steam processes, is maybe not the same water you might need in different places. Is that true, that you need different kinds of water depending on what you’re doing?
Jeffrey Paquet:
Yeah, you need different types of water in the sterile processing department and in those processes. So at the sinks and at the washers and the ultrasonics, most of the water you’re using there is what would be classified Nasty 108 as utility water. Utility water isn’t necessarily the water you’re getting from the city, although many people are using water from the city, and maybe shouldn’t be because it doesn’t meet the specs for utility water. And there’s many reasons why it doesn’t meet the specs, because in many areas of the country, like Texas is a good example, a lot of the water in Texas has very, very high conductivity, and you begin to break down your instruments immediately when you put them in the sink.
Melanie Perry:
Wow, I didn’t know that.
Jeffrey Paquet:
Then as you go through the process, you are wanting to further decontaminate and make the instrument safe, so you’re using critical water, which if it’s properly devoid of bacteria, it’s also devoid of ions. So anything left on the instruments after washing it with utility water is swept away because critical water is very hungry for the things that it is missing. It wants to become utility water or tap water. So chemically, it’s trying to get rid of all of that stuff. That’s why when you final rinse, it’s much like using deionized water to clean up your dishes and have no spots. That type of thing. Various levels of water are used. Then for steam generation, it’s a good idea to have the cleanest water you can use to generate steam, because for the same reasons, you won’t be depositing things on your instruments that’s in the steam if the water is relatively neutral and purified.
Melanie Perry:
It’s interesting. It’s funny you bring up spots, because I’ve seen spots lots of times on instruments, and most of the time when I’ve called sterile processing, they’d be like, Why does my instrument have spots? A lot of times they’ll tell me it’s a problem with a detergent or it’s an issue with something that way, but I’ve never actually heard them blame it actually on the water itself. So are there multiple issues that might cause spots on your instruments?
Jeffrey Paquet:
Yes. So the issues are all interconnected because the detergents that they use are supposed to be formulated for the water that it’s being used in. And the problem can be that throughout the year, the municipality will be taking water from different sources often, which have different chemical makeups. Let’s say your detergent supplier comes in and they say, Okay, we’ve got a water test here. We’ll formulate your detergent, blah, blah, blah. Then six months later, it stops working – you’re getting spots, and it’s because the municipality, and they’re not going to tell you when they do this, generally, is switched water supplies, which has a different chemical makeup.
Melanie Perry:
That is fascinating. It’s also true that if maybe they’re doing construction in the city or they’re doing something that’s affecting your water delivery system, it can also muck up everything that you have formulated for your water, right?
Jeffrey Paquet:
Right. Yeah. I think of Flint, Michigan. We had a customer where that happened, where they had also been to have all sorts of problems with water. What happened is they had old pipes. They did a construction project in which those pipes were left to sit for a while and dry out. When they reintroduced water, everything that had dried out went into solution and was provided to the hospital. We’re talking rust, we’re talking biofilm, we’re talking all sorts of God awful stuff on pipes that are 100 years old.
Melanie Perry:
Yeah, that’s disturbing.
Justin Poulin:
You talked about DI and RO water and a lot about IFUs. We threw out IFUs, but we didn’t actually talk about how that goes into how instruments are validated. Where do IFUs come from and how are they created? I think it ties into AAMI really well, too. I think it’s important to connect to the dots because AAMI is a group of manufacturers in a lot of cases. Not necessarily only manufacturers, but- Stakeholders.
Jeffrey Paquet:
Stakeholders. Including clinicians and SPD people and whatnot. But it is a group of stakeholders.
Justin Poulin:
But I feel like it also does tie in with a lot of the FDA 510k type conversations. I want to connect those dots for the audience, too. I would imagine, Melanie, nobody really knows how an IFU is created or why it’s important or who’s actually validating that it’s accurate. I think it ties into the AAMI ST108 and this conversation about how to best manage it, too, because in those instructions for use, there’s all kinds of requirements, potentially, that, once again, can’t just land on sterile processing to manage alone. Jeff, do you want to talk a little bit about the 510k?
Jeffrey Paquet
Sure. I can talk a little bit about that. I’m a little bit more familiar on the equipment side than I am on the instrument side, but both the equipment used to process the instruments and the instruments themselves have to go through a process for validation. If, particularly with the instruments and particularly with sterilizers, which are the highest level disinfection you’re going to get, there’s a very strict FDA process in which they have to validate statistically that it’s capable on the instrument side to be cleaned as long as somebody follows the directions, and that the process is used for cleaning. There is a validated process there, for instance, around autoclaves, steam sterilizers. There has to be validated cycles, and they have to have a kill rate, and it has to be repeatable. But it is within the confines: If you use the equipment right, if you follow the cleaning instructions right on the instrument. And if you don’t do that, you aren’t guaranteed to get the outcome you’re anticipating. And so, AAMI, with its various standards, as well as ST108, is trying to provide the information that people need so they can be compliant with those IFUs, particularly like with water.
AAMI has attempted to establish levels of contaminants that are acceptable for most equipment and instruments. Now, that doesn’t mean it is for every equipment and instrument, and there may be some things that you have to pay attention to that are included in AAMI-ST 108, but it is pretty general enough that it’s acceptable.
Justin Poulin:
We’ve talked a lot about guidelines, and we’re educating a lot around 510k and AAMI that might be new to this audience, but let’s talk about what isn’t new to this audience, which is the AORN guidelines. And, Melanie, I don’t know if you’ve got those right in front of you, but there are guidelines that speak to water management. So, I thought maybe you could read that, and then Jeffrey, you can walk us through how you’re putting together a total package to really tie all these silos together into something that really works.
Melanie Perry:
All right. So yes, AORN does have a guideline completely dedicated to instrument cleaning. It covers all sorts of things, some in a very broad manner, simply because it’s just giving you an overall guideline. If you look at the guideline for instrument cleaning, if you go to Section 3, it’s all about water quality. In that section, the very first thing it says is, “In collaboration with clinical engineering personnel, facility engineering personnel, and infection preventionists, establish a process and frequency for monitoring the quality of water, as in utility water, critical water, used in decontamination processes as part of the organization’s water management program”. That’s their very first recommendation in this guideline. Then they’ve got a bunch of research and information underneath that point. Then they say that “water should be monitored and controlled according to a list of water quality values” that they do provide in the guideline that’s very informative related to pH, to bacteria, to endotoxins, your total organic carbon, and a whole bunch of other stuff I’m not going to read for this podcast. But it is there, and you can look at it in the guideline to all the things that they detail. Then they only have a couple of more recommendations. It says, “Monitor and control the quality of the water utility that is supplied to decontamination equipment like your washer disinfectors. You should monitor and control the quality of critical water in your holding tanks”. That references biofilms and other things within that guideline, within that recommendation. Then the last one says, Evaluate water quality after major maintenance and repairs of the water supply system, which we just talked about. Changes to the water distribution system that require a utility shutoff, because obviously, like we’ve discussed, it can affect your water quality in your department.
But what’s interesting is as much as we got information in the AORN guidelines about paying attention to our water quality, this is very high level, very thousand-foot view of what we need to do. I think that’s why we need AAMI to give us that prescriptive or that more granular direction when it comes to actually understanding how we take care of our instruments through managing our water quality. I guess my one question that comes to mind is then if I’m doing all this and I’m monitoring my water quality and I’m checking everything, what am I going to see on my instruments or what might show up in my department with maybe my washer disinfectors or other things that’s going to tell me that maybe I have a problem with my water?
Jeffrey Paquet:
It’s interesting because I’m not as familiar with the AORN spec, but basically all of what you talked about there gets incorporated in AAMI ST108. I have a feeling that probably AORN was a representative on there.
Melanie Perry:
I’m sure they were. I can’t speak definitively, but I would imagine they were.
Jeffrey Paquet:
Right. I think they’re in step together where they talk about water quality management plans, looking at water quality after a major disruption, monitoring on a regular basis. All of that is very consistent with what ANSI/AAMI AT108 is telling you. So anytime the instruments don’t look right, I think there’s a good chance that that could be a water problem. It doesn’t mean it is a water problem, but it could be a water problem. If they’re discussing They’re colored, they’re stained, you have spots, they have dull area or something on a critical feature. All these things could be a result of corrosion, water hardness, pH problems. These are all indicative of those problems. It doesn’t mean they are, but it could be. It could absolutely be. Another problem that isn’t necessarily water in origin, but finding specs or debris on the instruments. It’s often waterborne, but doesn’t mean it’s coming from the water. But usually there’s a problem in the process someplace that’s introducing that.
Justin Poulin:
Can we talk a little bit about how hospitals are typically managing this today and why your approach at VERDA is somewhat transformative and really helping them be able to meet all these ANSI/AAMI ST108 guidelines because it is more prescriptive now. We mentioned in the state of New Jersey, you have to follow these guidelines. These aren’t recommendations and guidelines. These are you must do this in the state of New Jersey, and who knows what states might follow. But just raise the level of awareness, like why is this so elusive for facilities today?
Jeffrey Paquet:
What we observed early on in trying to do this ourselves is, and I liken it to patient care There’s different ways to do patient care. All hospitals, they all have AORN guidelines. They have all of the licensing stuff they have to do. They’re very much doing the same things. But care from hospital-hospital can vary greatly. It’s all in the implementation of how you take all those guidelines and manage the patient’s care. The way water is being managed typically today is much like maybe I’ve seen in the past, quite some time ago in hospitals, where no one was really in charge of the patient and their case. There was people that did this job, people that did that job. There’s a chart. People are supposed to come in, pick it up, read it, do the right thing, and leave enough information for the next person that comes on. Nobody was responsible, but everybody was responsible. More modern care, usually, is where there’s actually somebody who is responsible for that case, for that patient. Even though people come in and out of the team that are supposed to do their job, there is somebody that’s tying it all together to make sure the patient is getting the care. What we try to do is apply that same principle of care to the water that modern hospitals apply to the patient, rather than having it be the facility’s job does this, and SPD is supposed to do that, and Biomed does this in terms of water and managing water and vendors and laboratories and interpreting results. We have a team at VERDA that basically leads the all this. We provide representation to the water management team that comes up with the water management plans in the hospitals. We’re keeping people informed, but we’re taking action and we’re interpreting results and telling the people who need to make decisions in the hospital what the best course of action is to take at any given time.
Justin Poulin:
It can change, right? It’s not like, Oh, we put in this water quality management system and now we’re good. We can set it and forget it. There are a lot of things environmentally outside of the facility that can actually change the conditions of the water and would require periodic adjustments and monitoring as well.
Jeffrey Paquet:
Right. Even the guidelines that Melanie refers to AORN refers to that when there’s disruption in utilities or some change like that. You need to re examine your qualification process for your understanding of what water quality is coming to you.
Justin Poulin:
Are you guys only working with large health systems? In terms of your scale or who really needs you, can you outline that a little bit, too? Because I can see where you talked about water quality changes. I bet that happens in urban settings a whole lot, right? Whereas maybe a little bit less in rural settings, do you have a pretty broad footprint? Maybe talk a little bit about scope.
Jeffrey Paquet:
Right. In terms of our capability, we’re nationwide. Really, everybody who is processing instruments could use this type of approach. The old paradigm is in looking at the way water quality is managed. It’s just seen as a cost center. We’ve got to pay for the lab to do this. We got to pay for the guy that maintains the equipment. We got to pay for the equipment and everything, and it’s just cost. But if done rightly, it’s a return on investment. What you’re getting back is if you stay on top of water quality, what you’re getting back is time in the OR, reduction in surgical site infections, a lower inventory carrying costs for instruments because you’re not having to replace them, repair them, reduces the whole quality control overhead that you have in SPD for identifying instruments with problems and that type of thing. So even though maintaining water properly can look expensive to smaller organizations, in the end, it pays for itself, even on that scale. Because What you are getting back is OR time and less overhead around managing problems that you have no idea what the origin is.
Justin Poulin:
I heard you talking about maybe what some indicators are earlier that you might have a water quality issue. I think ANSI/AAMI ST108 also creates a need to have somebody come in and help meet those new guidelines. But I’m also thinking, what about construction? How important is it to bring in a team like yours at VERDA whenever there’s going to be a major renovation or new build? I got to think setting that tone from the very beginning of the project, that would be another reason to make sure that somebody gets you involved.
Jeffrey Paquet:
That’s a great question. It’s something we run into all the time, is that people are starting to build new departments, maybe even they get the right system in. But the system is only the thing in the closet. It is not the water quality management plan. Good water doesn’t magically come out there and touch your instruments. A lot of things can happen to water along the way as it goes out to the department and back to the equipment to be repurified and decontaminated. The way in which you plumb the sinks from your critical water piping to the sinks to the various pieces of equipment like the washers or the autoclaves, can greatly impact your ability to particularly control bacteria problems in water. Unfortunately, a lot of those details are left up to the plumbers, because in the design process, nobody is specifying, this is exactly how you connect the washer from the loop piping. We need to make sure when we’re designing the department or choosing equipment, even, that we’re reducing the amount of what we call dead legs in the piping, which is basically long sections of piping where water can stagnate and isn’t constantly flowing.
We’re familiar with this from trying to prevent legionella. We don’t want water stagnating in parts of the building and reintroducing problems into the building. That’s what happens in SPD as well, when you have these long sections of flexible hose that connect a sink to the critical water supply, so the sink can go up and down for ergonomic reasons. There’s a whole big problem with sinks right now, is what we’re experiencing is that they’ve been designed around ergonomics, but not around preventing surgical site infections, because they’re great. They go up and down, they do all sorts of cool stuff, electronically, modern temperature and everything. But there’s this massive amount of plumbing behind it that is not circulating on a regular basis and can introduce bacteria into the process. We’re beginning to try to impress upon the sink manufacturers that we need to take a look at this if you’re going to be successful.
Melanie Perry:
Oh, my goodness. I know it’s more than just having a filter for the water coming into your system. I do know that, but I don’t think we all really think about all of the things that go behind the science of water. It really does feel like that would just be a common assumption. Oh, you just need a filter, or you just need something, and it’s fine. That’s really not the case. To think about all of those variables is mind-blowing.
Jeffrey Paquet:
Right. I mean, it’s just like caring for patients. You can’t just do a couple of things and expect they’re going to be fine. You have to constantly monitor them. Situation changes. Environmental factors can come into play. There’s all sorts of things that can make things go sideways. It’s the same exact thing with water.
Melanie Perry:
Yeah. To think about also, and you mentioned this on our prep call before we ever had this conversation, but I think it ties in here very well to understand the importance of our water and how all of our water needs to be managed appropriately, ultimately, for patient safety. But we think our tap water is safe. They say we can drink it. If I can drink it and it can go in my body, then it has to be safe, right?
Jeffrey Paquet:
Wrong. So generally, tap water for municipalities is very safe to drink. But once you open a patient up, you don’t want to dump that water in that patient because there’s all sorts of stuff in that water that your body can process. But once this body’s own sterile field has been compromised, it’s deadly.
Melanie Perry:
That’s mind-blowing.
Justin Poulin:
Jeffrey, let’s talk about Belimed and Morristown. Sure. Just as we’re wrapping up the conversation. I think that both of these relationships really highlight the value that you’re bringing out there and the need that you’re filling that really nobody else has tackled.
Jeffrey Paquet:
Right. This puts a bow around why we think we offer a really effective program for hospitals, because Belimed realized a while ago that they were getting a lot of questions about water, that SPD facilities, Biomed, we’re all struggling with the new spec. We don’t know how to do this. We’re having problems. We don’t have the expertise. We go to the people that provide us the equipment and do our service, and they don’t offer help. They don’t understand what we do. They don’t understand instruments. And so they reached out to a bunch of these companies and said, “Well, look, this is the type of help that my customers need. What are you going to do to address that help that they need?” And the product manager said to me, “it was the most disappointing conversations I think I’ve ever had in my career”, is they basically said, “We’re not interested in helping. We’re willing to do what we do. But interpreting things, helping them through stuff, that’s something that we just can’t take on. That’s not what we take on”. It was the only thing that made us successful with managing water in our mobile fleet of departments. We can’t imagine how anybody else is going to be successful without doing things this way. When they spoke with us, when Belimed spoke with us, and we checked all the boxes for all of what the customers were asking for in terms of, we don’t just need a report. We need a report that tells us what to do. And then we may need you to help us do it. Those are the types of services that we provide. We have a customer in New Jersey that had to transition to ANSI/AAMI ST108 by law. They had a very common industry partner that people have that provides very fine equipment, but they needed more. They needed somebody to really make them compliant. And so now we’ve been working with seven of their facilities and providing that help that they needed. The validation to us is they, out of the blue, call up my people and say that “it’s like a breath of fresh air. I feel very good about the fact that we are on top of this. I know what’s going on with water, and we feel comfortable saying that we’re delivering good care to our patients.”
Justin Poulin:
Yeah, and they’re meeting the ANSI/AAMI ST108 guidelines, right? Because New Jersey has their Department of Health has adopted this as part of their regulatory responsibilities and licensing. That’s right. What’s also interesting, I’m going to throw a little kudos your way to your team that was involved in contributing to the development of the AAMI standard. Again, I think a lot of that guidance was about ensuring that those guidelines were also attainable. You could throw out a lot of guidelines, but that doesn’t mean hospitals can comply with it. It sounded like your team had really acted as a voice in advocacy for health systems and what’s realistic.
Jeffrey Paquet:
Right. Probably most health care providers have all been subject to do this. Somebody comes with a bunch of great ideas about how we’re going to implement these things, and this is going to be the greatest thing. It’s the actual implementing it that really becomes difficult. So we were really the voice of, look, we do this. We know how hard it is. We need to be rigorous, but we also have to be practical, and we can’t be unrealistic, because if it’s unrealistic, it’s ultimately going to fail and not achieve the goals you want to achieve.
Justin Poulin:
Well, we’ve talked about a lot of things, and I still think we’ve only touched or scratched the surface of ANSI/AAMI ST108. We’ve talked a lot about why it’s important, but if somebody went and actually downloaded ANSI/AAMI ST108and following up with this podcast, they might find themselves a little confused. And so what’s great is you all have developed a white paper to help demystify ANSI/AAMI ST108. We’re going to have a link to that so folks, after they listen, can download that white paper and get that put a little bit into perspective and give the background on it and explain in actionable way, it’s like you talked about how to manage these new guidelines. Also, there is going to be a promotion for podcast listeners. If you go to VERDAwater. Com/contact, that’s V-E-R-D-A, water. Com/contact, you’ll be able to fill out a form, put first case in the subject line, and you can enter for a complementary ST108 readiness assessment on anybody who submits a form before June 30th. I don’t know, Jeffrey, if you want to add anything to that. Sure.
Jeffrey Paquet:
So basically, I think we’re going to create an online assessment tool in that we’re going to provide that to anybody. At the end of that, that’ll provide people with some feedback on their current situation, and they can take and run with that, or they can call us for more help. But I think we will be giving away, I know at APIC, at least, we’re going to be at APIC. So some of the people attend APIC from this section of the people, I don’t know, but we are going to be giving away a free assessment, which is a full day on site at your facility. We’ll do a bunch of testing and we write you a 32-page report that has both near, mid, and long term actionable things to do to get compliant and improve your situation.
Justin Poulin:
Well, I do think perioperative nurses, do some of them attend APAC? It’s in Phoenix, Arizona, June 16th to the 18th. They can find you there at Booth 1920 if they’re going. They can also follow you on your LinkedIn page. Just go ahead and search for V-E-R-D-A. We’ll have links again in the show, right up in notes for this podcast. Jeffrey, really, is there anything you’d that we didn’t cover or something that’s maybe important to reinforce as we wrap up?
Jeffrey Paquet:
Well, I think it’s important to reinforce that being compliant is achievable. It certainly is achievable. But improving your water quality and becoming compliant with a spec, it’s a process, and it takes time. It’s not something that you’re going to just hire somebody, anybody, and the next day you’re going to be compliant. You will take a number of years as you go through and improve things in your department. They’ll There’ll be capital items you need to improve. There will be process items you need to improve, and it takes a while, and it’s a journey, but it’s well worth it.
Justin Poulin:
That was Jeffrey Paquet, CEO at VERDA Water Quality Systems, talking about ANSI/AAMI ST108 and how to have a comprehensive total water quality management program. And really, to break down all the silos, Melanie. As he mentioned, plumbers get involved in set up the piping, but they’re not necessarily experts in other areas. They’re experts in plumbing, but not the full picture. I think that’s where VERDA really differentiates themselves. How interesting was it, too, that they had the first mobile operating room? I didn’t even know you could do that.
Melanie Perry:
Yeah, that’s really cool.
Justin Poulin:
Yeah, and I just don’t feel like people really have a good grasp on how important a water quality management program really is to patient safety. I saw your eyes light up when we talked about biofilms, even when you’re following what you know or have a greater awareness on with pre-treatment of instruments after the case. But to know that there are still risks if the water is not managed well, it’s scary. Like you said, “bacteria slime house”.
Melanie Perry:
Well, it is terrifying because you hear time and time again, you wash your instruments, keep them clean. Don’t let bacteria find a foothold, and don’t do these things. Then you realize that water can be just as dangerous and just as big of a risk to your instruments, and then ultimately, of course, to your patient safety. I think seeing water as more than just water is something that I think is important to us in the perioperative space because it helps us understand the bigger process of what’s going on with instruments being sterile, what’s going on with them, what’s the process of sterile processing to get them clean? It’s not just necessarily the people back there getting the instruments sterile, but it’s also all the way down to the water coming into our department. I really think that it’s a good reminder, like Jeffrey was saying, that we can drink a lot of stuff in our water, and we can have bacteria and endotoxins and all this other weird stuff in our water, but we don’t want to wash our instruments in it. We don’t want that to be part of what’s going into our instrument care. And understanding the importance of water is the big takeaway, I think, from this conversation, because it’s just not a conversation that we have in the operating room ever.
Justin Poulin:
Well, Jeffrey and his team at VERDA have a white paper to help demystify some of this because you’re right, Melanie. I think we’re exposing people to something that they haven’t thought about at this level of detail. So in the show notes, you’ll have a link to the white paper demystifying ANSI/AAMI ST108. You can also fill out their contact form and get a free assessment, but then also get an entered into a drawing for a free on-site assessment. If you are going to APIC in Phoenix, June 16th through 18th. You can visit their booth, 1920, at the show. Then finally, follow them on LinkedIn. Again, the link to their website, verdawater.com/contact. On behalf of Melanie and myself, thanks for listening to this Vendor Spotlight on First Case.