DR BIRGITTA BEDFORD – RESEARCH DIRECTOR, PROECONOMY LTD INFECTION CONTROL
Safe water in healthcare premises
The Safe Water in Healthcare Premises guidance document HTM 04-01, first published in October 2006 by the UK Department of Health, received an update in May 2016. The author looks at what is new in this latest revision.
In summary, the main changes from the original 2006 edition are: l The addition of guidance on the risk posed by other waterborne pathogens, not just by Legionella.
l The acknowledgement that the temperature control regime is the traditional approach and no longer the preferred strategy.
l The guidance now advises the consideration of other controls, to minimise the risk of infection by all waterborne pathogens.
l The guidance also advises strict adherence to the recommendations in HSE’s guidance document covering the control of Legionella bacteria in hot and cold water systems (HSG274 Part 2).
l The document includes guidance on the remit and aims of a Water Safety Group (WSG) and Water Safety Plan (WSP).
l Issues associated with thermostatic mixing valves have been recognised, and a supplement has been introduced, outlining specifications for these to deliver non-scalding as well as microbially safe water.
What does this mean? It is now necessary to ensure the safety of all water used by patients, residents, staff and visitors, and to minimise the risk of infection associated with all waterborne pathogens. This approach, therefore, now
applies to other waterborne pathogens, not just to Legionella. Pseudomonas aeruginosa, Stenotrophomonas maltiphilia and Mycobacteria are now also covered. A temperature control
regime may no longer be sufficient to minimise the risks created by these waterborne pathogens, and other control measures should, therefore, be considered. It now also advises the strict
18
adherence to the recommendations in HSE’s HSG274 Part 2, which includes detailed advice on the available control programmes. A Water Safety Group (WSG) is also
required now. This group has to be multidisciplinary and should not only include representation from estates teams but also from infection control; medical microbiology; nursing; augmented care; housekeeping and support services; medical technical officers; specialist
Dr Birgitta Bedford
Dr Birgitta Bedford was the first person to earn a PhD degree in Legionella control
from Cranfield University, UK. She is currently the Research Director for ProEconomy Ltd.
users of water (such as Renal units and departments offering aquatic therapy); and sterile services departments (SSDs). This group should implement, develop and manage a Water Safety Plan (WSP) together, to ensure the safety of all water. A further addition states that the
performance of thermostatic mixing valves (TMVs) should now be carefully monitored, to ensure that the risk of scalding and microbial contamination is avoided.
How does this affect a healthcare organisation? The infection pathways of waterborne pathogens, such as P. aeruginosa, S. maltiphilia and Mycobacteria, are more varied than those of Legionella and are not limited solely to the inhalation or aspiration of water droplets (aerosols). As a result, minimising the risk of
infection is not only restricted to preventing growth in water systems but also includes avoiding growth outside water systems. Therefore, the updated guidance stresses the need for clean, hygienic environments and practices. In water systems, preventing growth
and gaining control of all waterborne pathogens is difficult because they all thrive and are protected in biofilms. The latest version of HTM 04-01 recognises that biofilms are particularly problematic in water systems that are complex, such as those in healthcare premises, where the risk of infection is higher. Control programmes should therefore
not only be capable of removing biofilms, but they should also be effective against the free-floating pathogens that are released from these biofilms. It is known that temperature and
oxidising chemicals do not penetrate established biofilms well, that pathogens survive in water temperatures lower than 20˚C and higher than 55˚C, and that, due to gassing-off, it’s hard to maintain adequate oxidising chemical biocidal levels at outlets, without overdosing the water system.
IFHE DIGEST 2017
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68 |
Page 69 |
Page 70 |
Page 71 |
Page 72 |
Page 73 |
Page 74 |
Page 75 |
Page 76 |
Page 77 |
Page 78 |
Page 79 |
Page 80
