WATER HYGIENE AND SAFETY
Protecting the vulnerable and reducing the risks
Stephanie Allchurch, Product Development manager at Altecnic, discusses the importance of ‘getting it right’ when it comes to water system-related products and procedures in healthcare settings, particularly to protect vulnerable patients against waterborne microrganisms such as Legionella and the illnesses they cause.
While we hope that the worst days of the coronavirus pandemic are behind us, during the toughest of times, healthcare estates across the UK have often had to perform beyond their designed capacity since the start of the pandemic. Now, more than ever, we all understand the need for reliable, safe, and flexible spaces for the NHS to perform at its best. For healthcare estates and facilities managers, HTM 04-01: Safe water in healthcare premises, is a fundamental piece of technical guidance that must be adhered to when working with the wider Operations teams to adapt dormant spaces to be safe to accommodate vulnerable patients. In particular, HTM 04-01 part C – Pseudomonas aeruginosa – advice for augmented care units, describes how ‘hospital water is a recognised potential source of Pseudomonas aeruginosa, which is a microorganism that can act as an opportunistic pathogen and colonise and infect vulnerable patients’. It adds: ‘Several outbreaks of P. aeruginosa have been attributed to contaminated water systems in hospitals.’
Breathing in of aerosolised water We know that Legionnaire’s disease is responsible for approximately 2-9% of pneumonia cases, and that the disease is spread via the breathing in of aerosolised water contaminated with the Legionella bacterium, which can be created in environments such as hot and cold water outlets, atomisers, wet air-conditioning plants, and whirlpool or hydrotherapy baths.
Harmful bacteria, such as Legionella, grow in water systems where water is stored at between 20˚C and 60˚C, so it makes sense to keep water stored and distributed at temperatures above 60˚C to thermally disinfect systems, without use of chemicals. However, HBN 00-10
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A set constant outlet temperature ensures safe handwashing, showering, and bathing.
Part C: Sanitary assemblies, advises that outlets with water running through them at above 46˚C present a scalding risk, and should be labelled as doing so. It also advises that thermostatic devices, such as thermostatic mixing valves, should be used at each outlet to remove any risk of scalding.
Addressing scalding risk According to the Child Accident Prevention Trust, every year around 20 people die as a result of scalds caused by hot bath water, and a further 570 suffer serious scald injuries. Young children and older people are most at risk from bath water scalds, because their skin is thinner, and therefore less tolerant to higher water temperatures than that of other age groups. As a result, they sustain scalds more quickly, at lower water
Every year around 20 people die as a result of scalds caused by hot bath water, and a further 570 suffer serious scald injuries
temperatures, and often with a greater depth of burn.
Not only that, but ‘risk of scalding’ is still on the NHS ‘Never Events’ list, which was last updated in February this year. This is a list for all organisations that provide NHS care of serious incidents that are wholly preventable because guidance or safety recommendations are available at a national level, and should have been implemented by all healthcare providers. Thermostatic mixing valves (TMVs) are used to blend hot and cold water to maintain a set constant outlet temperature. This ensures safe and comfortable handwashing, shower, and bath temperatures. This significantly reduces the risk of scalding.
Applicable TMV testing and regulatory standards for NHS facilities
In order to store water at temperatures that will thermally disinfect the water system, we must specify a thermostatic mixing valve that adheres to the strict testing regime of the TMV3/NHS D08
April 2021 Health Estate Journal 65
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