WATER HYGIENE & SAFETY
with clinical data, and is therefore not given the same attention when it comes to the analytics required to produce actionable insights. There’s a clear need to shift perceptions on the importance of water data as another critical solution for creating a sustainable, yet safe NHS. Of course this perspective, and implementing an agreed baseline data collection set for all Trusts, is not something that can be done easily and consistently without significant effort and collaboration across the board. One issue is the variety in the NHS’s estate portfolio – its new projects, existing assets, and retrofitted facilities, all collect data in different ways and different formats. Depending on the age of the estate, there will be different interventions that have vastly different definitions of success as regards water and carbon efficiency.
Armitage Shanks says that ‘understanding how facilities are designed for hygiene and water efficiency is central to dealing with the sustainability demands of the NHS’s water use’.
wastage of water. However, this monitoring of data cannot be centralised or focused on a few locations. Instead, data is required from across the different Trusts for useful comparisons and contrasts to be made, as well as for generalised and Trust-specific plans to be put in place.
The Forum was chaired by Elise Maynard, director of the Water Management Society, and an independent microbiologist.
How recent is the data? Where data is being gathered, there are further issues to overcome – principally as regards how recent the data is, with the lead time for data publication often leaving Water Safety teams working with data that is more than two years out of date. The availability of water data is a stark contrast to clinical data, where real-time feeds are available. However, this isn’t the case globally. The federalised system in the US allows for the devolution of data gathering, and could be implemented within the UK for individual Trusts to collect, analyse, and act on water data. Yet this solution relies on establishing a baseline that Trusts can work from and then build on, making it easier to measure progress across the NHS, and then apply more specific solutions.
Alongside the availability of
data, there are challenges when it comes to how data is valued by various stakeholders – data from Estates and Facilities is seen to be undervalued compared
Designing for real use Understanding how facilities are designed for hygiene and water efficiency is therefore central to dealing with the sustainability demands of the NHS’s water use. This needs to be considered at each stage of the design process, with the clinicians consulted throughout, to assist with addressing the conflicts that come with reducing water use but maintaining patient safety. For example, a specific example raised at the Water Safety Forum was removing basins in patient bedrooms where there is already one in a bathroom. This may appear to be an simple change to minimise water usage and maintenance costs, freeing up staff for other critical activities. However, this change would present potentially severe clinical risks, encouraging clinicians, patients, and visitors to wash their hands in the bathroom where patients brush their teeth. Collaboration is clearly key if the sector wants to set a basic level of design competency that addresses both sustainability and hygiene concerns, while understanding behavioural and cognitive factors for the design of new facilities and the refurbishment of existing ones. This knowledge then needs consistently monitoring and updating, in line with the latest learnings, to ensure the continued safety and optimisation of facilities. Currently, there are identifiable design issues that have been implemented in line with existing guides and legislation that don’t account for the variable factor – people. For example, in rooms where every bed has its own sink, patients and visitors will still use the sink in the middle of the room because it is the most visible, leaving the others underused, wasting water, increasing a facility’s carbon footprint, and offering opportunities for biofilm build-up. Another example is the presence of hand towels above
sinks, which might be seen as instinctive design, but also poses a healthcare risk when parts of the towel come apart and are flushed down the sink by users. At the core of this is the fact that design guidance itself has been too slow to evolve and be published for use by Trusts and in the construction of new facilities. Often the fact that guidance is only updated every 5 to 10 years, and that writing a guidance document can take up to two years,
In October 2020, the NHS committed to reaching carbon Net Zero by 2040 – making it the world’s first health service to do so. While the ambition of the NHS cannot be understated in its aims, the scale of the service, and the challenge it faces, are vast
54 Health Estate Journal January 2025
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