WATER HYGIENE AND SAFETY This photo from


Pharmafilter shows vertical membrane bioreactors. The company said: “We apply downward flow to


achieve greater efficiency, cost-effectiveness, and longevity. The pumps,


valves, controls, and all other equipment, are supplied by leading manufacturers, and


include dual redundancy within the system design and layout.”


in use. Now, more than ever, the healthcare sector is required and expected to treat and care for patients while also contributing to a sustainable environment. Eliminating clinical waste on site, and having the


ability to control discharge to the sewer, will prevent contamination. Any discharge to the sewer, other than domestic water, must have the prior agreement of the statutory responsible bodies. Anybody intending to dispose of any waste to the sewer that may present a substantially greater risk of damage to the sewerage undertaker’s assets than domestic sewage should first seek advice from the sewerage undertaker. HTM 07-01: Safe and sustainable management of healthcare waste guidance,8


states: “The Controlled Waste (England and


Wales) Regulations give legal definitions of ‘clinical waste’ and ‘offensive waste’. Such wastes are regulated due to their toxicity, hazardous nature, and capacity to do harm to human health or the environment. This regulation sets out a statutory obligation to ensure that the waste is managed appropriately to prevent harm.” In summary, key to the preventative strategies to mitigate


Karina Jones


Karina Jones C.Eng, MIET, FIHEEM, MWES, M.W.M.Soc has many years’ experience in water management, working closely with NHS Trusts and water management companies in her role as an IHEEM- registered Authorising Engineer (AE), and providing independent and impartial advice to clients across a wide range of challenges in this specialised industry. She has extensive


experience providing advice on water hygiene management, advising clients on the legal drivers for statutory obligations and ACoP L8 compliance, and providing comprehensive guidance on microbiological waterborne contamination in water systems to NHS Trusts across the country. She is a strong believer


that Authorising Engineers should not only highlight areas of non-compliance, but should also support clients towards effective solutions. She is a Fellow of IHEEM, and a member of the IHEEM Water Technical Platform.


change of a use from a clinical space to a storage area, will create the need for frequent flushing implementation. As water prices increase, so too will the need for careful water management and stewardship. It is clear that good water management, including


effectively managing clinical waste and wastewater, has a huge impact on patient safety, as well as an environmental impact.


Managing clinical waste As well as addressing the challenges and risks associated with water outlets and drainage in healthcare settings, we must also look to the overall management of clinical waste. NHS healthcare providers produce approximately 156,000 tonnes of clinical waste annually that is either sent to high temperature incineration (HTI), or for alternative treatment (AT), which is equivalent to over 400 loaded jumbo jets of waste. This has a significant environmental impact, and is associated with both high running costs and carbon emissions. The NHS England Clinical Waste Strategy, published on 7 March 2023, sets out NHS England’s ambition to transform the management of clinical waste by eliminating unnecessary waste, finding innovative ways to re-use, and ensuring that waste is processed in the most cost-effective, efficient, and sustainable way. Therefore, the potential benefits of a combined on-site hospital wastewater and mixed waste treatment platform system designed to address the pressing need for sustainable waste management in healthcare settings should be investigated. By deploying advanced technology and


techniques, innovative systems can effectively remove pharmacological, biological, chemical, microbiological, and micropollutant contaminants, including drug-resistant pathogens, thereby mitigating environmental and health risks. The approach prioritises patient care while delivering positive impacts on clinical, environmental, and economic fronts. The integration of precautionary measures and automation reduces human error and minimises contact moments, enhancing safety and efficiency. This approach is available through several companies, and is already


52 Health Estate Journal August 2025


the risk from wastewater is the approach and attitude of the personnel responsible, a clear understanding of how wastewater and clinical waste are removed and disposed of, and an acknowledgment that, where possible, prevention is better than cure. Preventing inappropriate and unnecessary discharge of contaminates into drains will reduce both waterborne pathogen proliferation and contamination of sewer systems. Even more importantly, understanding the importance of avoiding fouling of drains will reduce the increasing risk from antibiotic-resistant bacteria in healthcare settings.


References 1 Past Lives. Journal of the International Federation of Clinical Chemistry 2003; 14(1): 40-41. https://tinyurl.com/u2npbsyj


2 A waste trap sterilising method. Kohn J. The Lancet 12 September 1970; 296(7672); 550-551. https://tinyurl. com/55uamf3y


3 BS 8680:2020 Water quality. Water safety plans. Code of practice. bsi, 30 May 2020. https://tinyurl.com/bd9tsrnu


4 Park SC, Parikh H, Vegesana K, Stoesser N, Barry KE, Kotay SM et al. Risk Factors Associated with Carbapenemase- Producing Enterobacterales (CPE) Positivity in the Hospital Wastewater Environment. Appl Environ Microbiol 2020 Nov 24;86(24)


5 Breathnach AS, Cubbon MD, Karunaharan RN, Pope CF, Planche TD. Multidrug-resistant Pseudomonas aeruginosa outbreaks in two hospitals: association with contaminated hospital waste-water systems. J Hosp Infect September 2012; 82(1):19-24. https://pubmed.ncbi.nlm.nih.gov/22841682/


6 Coyne AJK, Ghali AE, Holger D, Rebold N, Rybak MJ, Therapeutic Strategies for Emerging Multidrug-Resistant Pseudomonas aeruginosa. Infect Dis Ther 2022 Feb 12;11(2):661–682. https://pmc.ncbi.nlm.nih.gov/articles/ PMC8960490/


7 Health Technical Memorandum 04-01: Safe water in healthcare premises: Part A – Design, installation and commissioning and Part B – Health Technical Memorandum 04-01: Safe water in healthcare premises – Part B: Operational management.


8 HTM 07-01 (2023 version): Safe and sustainable management of healthcare waste. Updated 7 March 2023. https://tinyurl. com/bwd999fu


Further reading n Environment and sustainability. Health Technical Memorandum


07-04: Water management and water efficiency – best practice advice for the healthcare sector. Department of Health, 20 March 2013. Updated 26 January 2024. https://tinyurl.com/ y8h6rpmv


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