Contaminated Drinking Water

By Kim Smiley

In 1922 the United Nations designated March 22 as World Water Day.  In honor of the occasion, a report titled “Sick Water” was published this week detailing issues with water pollution throughout the globe.

According to the report, two billion tons of pollution consisting of human and animal waste and industrial chemicals are dumped into waterways every day.  Almost 80 percent of sewage around the globe goes into waterways untreated.

Millions of people lack basic infrastructure including access to clean water, sanitation systems and water treatment facilities. The massive water pollution that results from this situation kills nearly 1.5 million children under age 5 every year.  Over half of the hospital beds in the world are occupied by people with illnesses caused by drinking contaminated water.

Even in developed nations, water pollution is a problem because many chemicals aren’t removed by the water treatments that kill the pathogens from sewage.  Chemicals from antidepressants, birth control, illegal drugs, sunscreen, and insect repellent are just some of the pollutants that have been found in US drinking supplies.

In addition to human illnesses caused by dirty water, water pollution has a large scale impact on the environment.  Over two billion tons of water is polluted daily, resulting in death of fish and choked coral reefs.

While the problem of water pollution isn’t a problem that is traditionally approached by root cause analysis, a Cause Map can be built to examine the causes of a wide range of issues.  Click on the “Download PDF” button to view a high level Cause Map of this issue.  The Cause Map could be expanded to incorporate as many causes as desired.

Power Outage Chile

By Angela Griffith

A power outage struck Chile less than a month after an earthquake struck.  The power outage affected an area of nearly 2,000 kilometers and roughly 80% of Chile’s population.  Power in most areas was restored within several areas.  However, it was estimated that power to some in the Bio Bio region – which received more severe infrastructure damage – might be out for the better part of a week.

A power outage is an impact to the customer service and production/schedule goal.  The power outage was caused by the collapse of the Central Interconnected System (Sistema Interconectado Central).  The grid collapse was due to a lack of backup power capabilities, which was caused by a fragile power grid as a result of the earthquake, and interruption to the main power grid.  This interruption was caused by a disruption at the biggest substation due to a damaged transformer.  It’s unclear what caused the damage to the transformer, but it is believed to be related to the earthquake that hit in February.  We show this by adding a cause box with a question mark between “damaged transformer” and “earthquake on Feb. 27th”.

Repairs to the damaged transformer were required, which is an impact to the property and labor goals.

The Chilean government pledged to repair the transformer within 48 hours and stabilize the transmission lines within a week.  Interim solutions to get the electricity flowing were to isolate the damaged unit and install a reserve.  Additionally, Chileans have been asked to conserve electricity to minimize the amount of power transmitted through the lines.

By clicking ‘Download PDF” above, you can see the thorough root cause analysis built as a Cause Map that captures all of the currently known information in a simple, intuitive format that fits on one page.

Even more detail can be added to this Cause Map as the analysis continues. As with any investigation the level of detail in the analysis is based on the impact of the incident on the organization’s overall goals.

Salmonella Recall

By Kim Smiley

A number of food products have been recalled recently because of potential salmonella contamination.  The recall list is still growing and has the potential to affect thousands of items in nearly every aisle at the grocery store.

The contamination originated in hydrolyzed vegetable protein (HPV) which is a common, inexpensive salty and savory flavor enhancer used in a variety of products.  All HPV from Basic Food Flavors of Las Vegas made since September 17, 2009 has been recalled.   For a list of all recalled items and more information, please visit the Food and Drug Administration webpage.

The salmonella contamination occurred in the processing equipment at a one location, but HPV from that supplier was sold to food manufacturers nationwide.  HPV is a specialized product and there are only a few suppliers for it so issues at a single supplier have the potential to affect a significant percentage of the processed food supply.

The contamination was identified when a consumer of the Basic Food Flavors identified salmonella in a batch of HPV they had purchased and reported it to the FDA, utilizing the new FDA Reportable Food Registry.  The FDA then inspected Basic Food Flavors and found salmonella in the plant’s processing equipment.

The overall risk to the public is considered low.  No cases of illness from this contamination have been reported.  As long as products are heated to a sufficient temperature, either during the manufacturing process or cooked after purchase, the salmonella risk will be eliminated.  The highest risk products are ready to eat products such as chips, dips, and dip powder.

The investigation of this incident is still ongoing, but a basic root cause analysis can be started.  The safety goal is obviously impacted since salmonella can potentially cause illness and even death in the case of weakened immune systems.  In this case, the customer service goal would be impacted as well because the recall may affect customer confidence and sales of the recalled items.

Click on the “Download PDF” button to view an initial Cause Map of the salmonella contamination.  The Cause Map can be expanded as more details are available.

Water Pollution from Sewer

By ThinkReliability Staff

Thanks in part to the Clean Water Act, passed in 1972 and revised in 2000, most residents of the United States have continual access to clean, safe water.  However, extenuating circumstances may result in pathogens remaining in drinking water – or contaminating swimming water – resulting in potential illnesses.  In fact, researchers estimate that up to 20 million people per year become ill due to ingesting pathogens in water.  In addition to the environmental impact of untreated sewage reaching waterways, up to 400,000 basements and thousands of roads have been flooded with untreated sewage.

These floods generally occur when the sewer systems are overwhelmed or clogged.  A clogged sewage system can result from buildup of leaves, or other debris, including that from illegal dumping.

An overwhelmed sewer system is generally the result of a high volume of water passing through the system.  As the population increases, the strain on the system increases as well.  Since most municipalities do not have the funds available to upgrade or replace their systems, an aging, inappropriately sized system is all that remains to provide needed water.  However, systems are generally able to keep up with demand, except during times of high rainfall.  Many sewer systems handle both waste and rainwater through the same system.  When a heavy rainfall occurs, the system is overwhelmed, resulting in overflow of sewage.  This overflow is often directed into the waterways.  Dumping untreated or partially treated sewage into waterways is illegal, but fines are hardly ever levied.  The Federal Government may be unwilling to levy fines against municipalities for illegal dumping, especially because Federal funding to maintain sewer systems has decreased significantly.  With municipal budgets stretched already, dealing with aging sewer systems just isn’t happening.

However, there are some things that municipalities can do.  Green spaces (as opposed to paved areas) absorb rainfall, decreasing the amount directed in to the sewer system.  By planning more green space, or better drainage, the amount of rainfall that actually enters the system can be reduced.  Additionally, municipalities could redirect rainfall to keep it out of the waste portion of the sewer system. The cost of doing this may make it infeasible; however, calls for Federal stimulus money for repairs to sewer systems may result in municipalities’ ability to finally upgrade their systems.