WATER HYGIENE AND SAFETY
with some disruption to clinical activity. Much could be done to improve current thinking and practice on domestic water system design, and the placement and use of healthcare water assets. The ‘NTM addendum’
is
The control panel of a Pharmafilter system user interface, which is also connected to the hospital Building Management System, and allows remote operation by both supplier and user. Pharmafilter offers an automated solution that decontaminates waste and purifies hospital wastewater at its source. Pharmafilter said: “The system provides on-site waste and wastewater decontamination, and purification technology tailored to the needs of modern healthcare.”
clear of Pseudomonas aeruginosa bacteria before they are returned to clinical use. This process requires vigilance – not only from the mechanical aspect of water management for waterborne pathogens such as Legionella risk assessments covering the configuration of domestic water distribution systems, but also in terms of input from all members of the Water Safety Group in relation to the clinical risk assessment. There needs to be wide-ranging involvement from all responsible for water management as part of their duty of care to ensure that patient safety is paramount.
Purified process wastewater storage with a UV tank.
Testing in line with HTM 04-01 Healthcare domestic water systems, especially in high- risk areas, are frequently tested in accordance with the HTM 04-01 guidance to ensure that we are one step ahead of any possible contamination. However, I would question whether focusing on the water discharge point alone is sufficient to ensure that transmission to patients is eliminated? We all know that handwashing performed at a handwash station – an interface between water and drainage – provides an important barrier to cross- infection systems. However, the associated hazards from the drainage system go largely unnoticed, and yet a large percentage of washhand basin drains are heavily contaminated with P. aeruginosa. It is well recognised that within healthcare, reports of outbreaks linked to distribution water systems outside of neonatal units are over- represented by multi-resistant organisms, and increasingly by carbapenemase- producing organisms (a group of bacteria) – germs which produce carbapenemases (enzymes) that destroy antibiotics called carbapenems. Designs that promote or disturb drain biofilm, misuse of sinks, and placement of patient care materials adjacent to sinks, have all been associated with sink- related infections. It is not unusual, as part of remedial works, for Estates Department engineers to have to remove contaminated pipework at considerable cost, and
50 Health Estate Journal August 2025
a supplementary document related to Nontuberculous Mycobacteria (NTM) disease, and provides guidelines, particularly in the context of healthcare or public health (NHS Estates Technical Bulletin (NETB) No.2024/3). It recommends not incorporating 90-degree bends in water or wastewater pipework, as these increase the risk of blockages, corrosion, and scaling, which adversely affect system flow and temperature controls. Other potential areas for improvement and positive actions towards controlling contamination include a preference for us of waterless or low-water-use solutions in augmented care settings where possible, and placing washhand basins at the entry to high-risk areas, preventing unnecessary risk of proximity to patients. Another potential step could be implementation of augmented care washhand basin area zones – for example incorporating different-coloured 0.5 m zones around sinks to discourage placing items within the area that can be cross-contaminated and passed on to patients by contact. Screens, or raised washhand basin sites, would also help. Hospital design must take into consideration patients’
safety, functionality, and be practical. The practical part often falls under the influence of human behaviour. Water Safety Group members play a key part in ensuring that all aspects of water management – including managing wastewater – are overseen and managed in accordance with current guidance and regulations. Inappropriate actions of staff, patients, and the public, and the placement of unnecessary items at water outlets, play a big part in contamination spreading. For example, simply ensuring that clinical sinks and washhand basins (CWHBs) are used strictly for handwashing, and that no items are placed on or near a drain (such as placing patient water jugs directly on the sink base or drain when filling them), will help to prevent cross-contamination. Staff should also ensure that shower outlets are correctly tethered (as per water regulations), and never left to lie on the shower base, especially over the drain. Equally, fitting shower drains in an offset position to prevent patients from standing directly on them is also good practice.
Multidisciplinary group’s knowledge Water Safety Group members hold a wide range of knowledge, with the ‘WSG’ being a multidisciplinary group formed to commission and develop an organisation’s Water Safety Plan (WSP) document, providing a detailed approach to comprehensive strategy to ensure that water is safe for all types of use – from the conception of a building water system, and associated equipment, through to its demolition. The Water Safety Plan should thus cover all aspects of water risks and how to address them, including wastewater control. Currently, there are no clear Planned Preventative Measures (PPMs) in place for drain maintenance other than as set out in HTM 04-01. BS 8680:2020 Water quality. Water safety plans. Code of practice3
should be considered. However, the Code of Practice is not widely implemented across healthcare, and such action should be included as part of a comprehensive Planned Preventative Maintenance programme. Appropriate control measures, communication, and
training, should always be implemented to minimise these risks of contamination. All healthcare staff involved in water management should be aware that the use of sinks to dispose of patient secretions, for example, has been
clearly states that risks from wastewater
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