comprehensive, the reality is that such a broad definition of competence is inevitably open to interpretation. There are currently no specific details about what ‘sufficient training and experience’ really means, which ultimately puts the onus on the individual healthcare provider to determine who can successfully fulfil the role. With the likelihood of inconsistencies occurring across the board, it is unsurprising that only 15% of respondents said the current system for what defines a ‘competent person’ is adequate.

What’s more, another question asked what our professionals would most like to see from infection control measures in the future. Almost half (43%) said ‘better training for competent persons’, which came above other considerations, such as tighter legislation and greater product choice. It’s evident that not only does the definition need clarifying, but that the role itself needs to be better supported.

Ensuring the right water temperatures

Currently, there are two key strategies in the supply of safe hot water in taps and showers — thermostatic point of delivery products, or the treatment of a warm water circulating system. With no hard evidence to suggest which is better, the decision lies in the hands of the competent person to weigh up the pros and cons. Our survey (see Fig 1) found that an overwhelming number of respondents believe that fitting thermostatic mixing valve (TMV) devices to a standard hot water system is the best delivery method. This system works by storing the water at a high enough temperature to kill harmful bacteria, such as Legionella, but reducing the temperature at the point of use to avoid scalding to users. The alternative approach requires specific chemicals or additives to treat the warm water circulating system, designed to minimise the risk of bacteria colonisation. This means that the water doesn’t need to be stored at a high temperature, negating the use of TMVs. Overall, these answers highlight the alarming level of disparity between working practices. Not only that, but individuals themselves seem confused about their own response. For example, despite two-thirds expressing their preference for this method, half (49%) said they felt unsure of the risks of TMVs. It’s clear that more research needs to be done into the methods to allow the ‘competent person’ to make a judgement based on concrete evidence.

Information and training

A central aim of the report is to determine whether healthcare professionals believe that the necessary guidance on infection control can be easily obtained. Since the

58 Health Estate Journal February 2021

Figure 1: Results of Bristan’s survey on respondents’ views on the best strategy for maintaining safe hot water in taps and showers.

Overall, our survey found that the thermostatic point of delivery method is more widely adapted

One-third use treatment of the warm water supply

Two-thirds use TMV devices on a standard hot water system

31% 69%

Bristan’s TMV3-approved H64 hospital mixer tap combines thermal flush technology and tamper-proof, easy-to-access isolation for quick thermal flushing, ‘in line with infection control measures’.

issue of infection control is one that affects the health and safety of both patients and staff, the level of information and training should be as extensive as possible. Unfortunately, this is not the case. When asked if there was enough information to make supporting infection control measures easier, an overwhelming majority said no. This lack of information is present on a wider scale too, with the majority of respondents (28%) citing training as the biggest overall challenge in terms of infection control (see Fig 2), closely followed by education and awareness (25%). The reason for the deficit in training and education could be down to the uncertainty which surrounds so many aspects of water delivery infection control. Many aspects are still being debated – such as the merits of thermostatic delivery hot water systems versus chemical water treatment – making it difficult to provide detailed, centralised guidance.

These results indicate that greater resource provision is needed from both the Government and trade bodies in order to meet the lack of education and

awareness. Alternatively, a Government/ trade body lead training and information ‘bank’ could be easily supplemented by relevant CPDs – for example, Bristan’s ‘A Clinical View on Brassware Specification’, and ‘Thermostatically Speaking’, RIBA- accredited CPDs.

Informing the future

Our snapshot of industry opinion has brought to light some of the key issues within infection control for water delivery – from the need for more information and education, to the ambiguous definition of ‘competent person’, to the lack of research and insight into different system approaches. While the white paper report showcases the challenges that healthcare professionals face within the realm of infection control, Bristan’s long-standing range of healthcare products is designed to make the jobs of specifiers easier. Our medical product range has been developed in close collaboration with healthcare managers and specifiers, and is based on extensive research into specific sector requirements. Always remaining customer-inspired, Bristan hopes to

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