An area technical operations manager (atom) reported that an aquabplus 2500 from one of their facilities had a motor protection switch failure.
It was reported that the power on the system tripped and the machine would not run.
Simultaneously, smoke was seen coming from the thermal contactor below the motor protection switch.
The atom stated that it was not a lot of smoke and confirmed that the smoke detector did not go off.
A burning smell was also noticed.
The atom tried turning the machine back on to run it in emergency mode.
As they did this, sparks and arcing were noted coming from the wires down by the contactor.
The atom stated that the hood of the reverse osmosis (ro) system was closed, so they were unable to see inside of it.
There were no reports of flames.
In addition, there were no reported alarms.
Patients were in treatment when the failure occurred, but there were no adverse events as a result.
The atom stated the facility has two separate ro systems, and the patients who were in treatment were relocated to the other half of the treatment floor where they utilized the other ro system to complete their treatments.
The event did not result in any incomplete treatments.
To repair the aquabplus 2500, the atom replaced the motor protection switch, the thermal contactor, the relay, and ancillary wiring.
The atom stated the damaged parts were returned for manufacturer evaluation.
The aquabplus 2500 was returned to service and reported to be fully operational.
As patients do not hook up to ro systems, there is no direct patient involvement associated with this event.
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