WATER QUALITY
geometry. Without that feedback loop between design, operation, and infection prevention, stagnation remains something people react to rather than something they anticipate.
From compliance to resilience For years, much of the sector’s effort was understandably framed around compliance: risk assessments completed, records maintained, temperatures checked, sampling reviewed, actions closed. None of that is unimportant. But compliance alone is a limited ambition. Resilience is a better one. A resilient water system is not one that merely passes its
next inspection. It is one that can continue to maintain safe conditions despite evolving building use, staffing pressures, refurbishments, heat stress, delayed occupancy, and the inevitable surprises of healthcare operation. It is a system that is designed with realistic use in mind, supported by workable controls, and reviewed when assumptions change. That is where the discussion around stagnation now needs to sit. Not at the edge of water management, but at its centre. In practical terms, resilience means accepting
that stagnation will always try to reappear wherever complexity, change, or inconsistency create the opportunity. It means designing systems that are less vulnerable to low use, choosing control measures that can realistically be sustained, and recognising that both outlets and drains deserve attention if patient exposure is to be reduced.
A final thought For all the technical detail surrounding stagnation, the governing principle is surprisingly simple. Water that moves is generally safer than water that stands still. Yet turning that principle into reliable practice across a living, changing healthcare estate is anything but simple. That is why stagnation still deserves more attention
than it often receives. It is quiet, commonplace, and easy to underestimate. But it shapes the conditions in which pathogens can persist, multiply, and in some cases reach the patient environment. It affects not only the supply side
At a glance: when water stands still
n It can begin to shift conditions in favour of microbial growth. n Biofilm turns plumbing into a persistent infection reservoir. n Low-use outlets make healthcare estates especially vulnerable. n NETB No.2024/3 reinforces the need for proactive control. n Manual flushing is often inconsistent and resource intensive. n Maintaining water movement is one of the most important preventive principles. n Combining system control and point-of-use measures protects patients.
of the water system, but also the drainage side, where splash and aerosols may carry consequences that were too long overlooked. In healthcare, water does not need to appear contaminated to become a risk, as standing water can create conditions that favour microbial growth.
Bibliography n Bacterial recolonization of hospital sink biofilms, Journal:
Journal of Hospital Infection. DOI: 10.1016/j.jhin.2025.05.013, PubMed: PMID 40466811
n NHS England. NHS Estates Technical Bulletin (NETB) No.2024/3: Supplement to HTM 04-01 Safe water in healthcare premises. The bulletin emphasises avoidance of stagnation, minimising splashing, controlling exposure to drains and aerosols, and the use of 0.2 µm point-of-use filtration for high-risk patients. (
https://www.england.nhs.uk/publication/ nhs-estates-technical-bulletin-netb-no-2024-3/)
n NHS England. HTM 04-01: Safe water in healthcare premises. The core UK framework for design, operation, temperature control, circulation, and safe management of hot and cold water systems in healthcare settings. (
https://www.england.nhs.uk/ publication/safe-water-in-healthcare-premises-htm-04-01/)
n Health and Safety Executive. HSG274 Part 2: The control of legionella bacteria in hot and cold water systems. Practical UK guidance on managing legionella risk, including the role of flushing, temperature control, and maintenance. (https://www.
hse.gov.uk/pubns/priced/hsg274part2.pdf)
Holger Eggert
Holger Eggert is head of product management and business development at Aqua free Group. With extensive experience in water hygiene, filtration, and medical devices, he leads the development of solutions that translate microbiological risk into effective, system- based approaches for healthcare environments.
August 2026 Health Estate Journal 45
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