WATER SYSTEM HYGIENE AND SAFETY


Figure 3: A history of the disinfectant levels at the hospital.


two locations meant that the probe could read the level of disinfectant circulating in the water distribution system through the hospital returning to the dosing unit, and then dosing chlorine on its departure from the heater and leading back through the hospital. The result was an improved level of control through the outlets, and a quicker response by the probe. Given that the hospital plumbers had


experienced several situations where the chlorine tanks had run empty or the pump had lost prime, a unit with remote telemetry was proposed. While still retaining the existing dosing pump, a controller was installed that allowed alarms sent via SMS or email. This meant that any failure in the treatment system could be identified immediately, and steps taken to rectify them quickly. HydroChem was engaged to undertake monthly services of the chlorine dosing system, reducing pressure on the site staff, and ensuring that the system was calibrated and operating properly.


Gap 3 – Focusing on high-risk outlets Sampling was adjusted to focus on showerheads, and to distribute the samples across all floors of the hospital. Monthly testing revealed that there was a delay in the movement of the treated warm water to all outlets, and hence a reduced level of chlorine in some areas. This was relayed to the Engineering team for review. Plumbers were engaged to balance the control valves throughout the system to ensure that water flow is shared equally across the whole system. After the review several steps were implemented, and in summary these included: n Implementation of a monthly maintenance programme for the dosing system commenced in July 2022.


n Reversing the dosing point and probe sampling point.


n Ceasing testing for HCC. n Taking samples from locations on each floor and focusing on showers.


n Testing free chlorine at each outlet during sampling.


n Installation of a dosing unit equipped with remote telemetry.


Following these changes, the hospital had 10 months of nil Legionella detections. Chlorine was maintained at all outlets, even when utilising the older controller. The site


staff were able to contact HydroChem when they noticed any issues on the controller display and prompt a service visit to rectify. A new dosing controller was installed


recently which allows the disinfection system to be reviewed from a computer or mobile phone, as well as receiving alarms when the levels drop below a critical point. The Engineering Department receives these alarms as do HydroChem. Disinfections can be initiated remotely as a remedial action prior to retests. Figure 3 shows a history of the disinfectant levels at the hospital.


Forming trusting relationships Probably the most effective change in the Legionella risk management process at this hospital was the way in which HydroChem was engaged with a clear remit. From the viewpoint of the Engineering Department, they had satisfied the requirements of the local regulations in a general sense, although there were ‘gaps’ between each of the mitigation steps. When invited to review the process,


HydroChem was given a very clear remit: ‘Reduce the number of Legionella detections”. Given that we had prior experience with people working at the hospital, it was not lost on us that HydroChem had to deliver a result. Strong relationships and maintaining a good reputation are paramount in our industry. I would not have accepted the project if I did not have confidence that we could affect a successful outcome. My confidence is built on real-world experience, and an in-depth knowledge of controlling Legionella bacteria in plant water circuits. We have no choice but to put ‘skin in the game’ coming in at this point of the process.


Getting the most from your Legionella management process Some simple steps that will help achieve satisfactory control of Legionella include: 1 Start at the beginning. Have a risk management plan completed.


2 When choosing a provider, ask for references for the individual who will be walking the floor of your facility. Make sure that the person engaged to conduct the risk management plan is a water hygiene expert – as opposed


to someone who provides generic risk management advice across broad categories of knowledge.


3 Request a detailed scope of deliverables – not merely ‘in accordance with a standard’. Make sure it includes the elements you will need, namely an assessment of the incoming water, a schematic of the hot, cold, and warm water systems, and a sampling protocol. There is plenty of guidance material available, and good consultants will help point it out.


4 Engage an experienced water treatment provider for any disinfection work. Look at its prior experience in dealing with potable water treatment specifically, ensure its involvement beyond simply inspecting the site every month, and make sure that it will be there when things go wrong.


5 Whether you chose to sample ‘in house’ or engage a sampling/ laboratory provider, make sure you have familiarised yourself with the recommended methods and follow them. Again, a good consultant or water treatment company ought to be able to provide guidance.


6 Keep in regular communication with the people managing each step. There should at least be a quick review of actions and results each month. You should speak with your sampling and water treatment provider at each service. Ideally the RMP consultant should be included periodically. Confusing compliance with risk management when trying to tame an invisible beast is fraught with risk.


n Acknowledgment


This article, titled ‘Legionella in warm water systems – Taming an invisible beast’, was first published in the December 2023 issue of Healthcare Facilities, the official journal of the Institute of Hospital Engineering, Australia, and was produced from the Institute’s National Conference 2023. HEJ would like to thank the author, the IHEA, and the magazine’s publisher, Adbourne Publishing, for allowing its reproduction in slightly edited form here. Thanks also to Iceberg Events for helping facilitate permission to publish the article.


February 2024 Health Estate Journal 33


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