WATER HYGIENE & SAFETY


There is also risk inherent in the installation of the dosing units needed to dispense biocides, which could themselves become sources of infection when the flow of water is interrupted. Furthermore, a lack of wider competency and knowledge on biocide use could result in issues with using and measuring different types of biocide agents, in particular when it comes to calculating the right dose ratios needed to provide effective protection.


(Left to right): Alyson Prince, Steve Vaughan, Professor Elaine Cloutman- Green, Terry Moss, and Peter Orendecki.


system filtration can be implemented, the cleaner the water flowing through the latter stages of the system will be, inhibiting bacterial growth by removing nutrients from the entire system, rather than just at the point of use. A key benefit of implementing this into new-builds is the cost and time savings gained from the beginning with cleaner water, rather than retrofitting this into existing systems, which would be costly and time-consuming, with the need to recirculate the entire water system. One example given in favour of point-of-entry filtration at the Water Safety Forum was a recent trial where the facility was being fed directly by rivers and streams – yet the filters were able to cope with the incoming microbes and clean water. The issue lies with the strain placed on point-of-entry filters that must filter algae and silt and become clogged quickly, resulting in the need for consistent monitoring and maintenance.


Anil Madan


Anil Madan joined Ideal Standard in 2017 as a Product manager, and is now UK Non- Residential Marketing manager for Ideal Standard and Armitage Shanks. With over 20 years’ experience in business-to-business marketing, and over 10 years working in the commercial sanitaryware sector, he has a wide understanding of the needs of healthcare professionals, installers, and end-users. In his role, he manages the Armitage Shanks brand range of specialist healthcare and commercial fittings and sanitaryware, ‘helping to drive innovation and raise standards in the sector to create the best solutions possible’.


Retrograde contamination However, point-of-entry filtration raises the issue of potential further contamination, or retrograde contamination, within the water system. Additional filters can be fitted within the water system to help keep water clean at all temperatures, but these filters would then need constant monitoring and maintenance to ensure a hygienic system – a time-intensive and costly process. Filtration is further caveated by the regional variability of different bacteria, and differences in water sources and quality, meaning a standardised filtration system is an unrealistic end goal to implement across Trusts. While filtration is an imperfect solution, and no filter can deliver thoroughly clean water, it can play a significant role as an invaluable risk management and carbon reduction tool when customised for each facility. In each case, filtration isn’t a magic bullet that will eliminate the need for heat altogether, but the right strategy would reduce reliance on the broad and carbon-intensive heating of huge amounts of water. Alongside filtration, biocides are an option for added


protection in the absence of, or reduction in, use of thermal control. One of the first considerations for biocide use, and one of the difficulties of getting their use right, is the need to tailor the type and amount of biocide to a system’s specific risk profile. This comes with its own set of problems, with the system needing to be up and running to determine where the risks are and how best to combat them with biocides. Again, the problem of regional variability raises its head


in this context, as well as the development of different microbial risks over the course of an asset’s lifetime. Other risks include the potential for biocides to mask instances of contamination that need to be addressed directly, such as broken filters, as well as the need to ensure that the biocide itself does not pose a risk to patients or staff.


56 Health Estate Journal January 2025


If implemented incorrectly, biocide could cause harm to existing water systems, or increase the risk of adverse effects on patients and staff. This is not to say that biocides will not have a role to play in the creation of a sustainable NHS. Both biocides and filtration allow the NHS to, in part, move away from carbon-intensive thermal control, but there is a long way to go to establish the processes and skills to enable this to happen on a large scale. The consensus of the forum was that there will be no single solution to the NHS’s sustainability and water safety challenges. Instead, progress will be made up of smaller, individual technological and procedural advances that intervene at different stages of water systems, of construction and design processes, and at different points in the patient experience. This reinforces the need for efforts to make decarbonisation and water safety work in harmony to be multidisciplinary. The regional angle was also a constant when it came to identifying the scale of the problem and implementing solutions. The call for a standardised set of more useful data was broad and consistent, but the reality of what that data looks like is varied, and more specific data is a necessity for each estate to address issues. The same goes with any attempt to move away from thermal control as a barrier to contamination – biocides and filters have to be tailored to the local situation, and that adds another element of complexity.


Complexity a key theme Complexity itself is a challenge that spanned the whole discussion – the more complex the solution to each of the problems the NHS encounters in its work to decarbonise, the greater the cost, and the greater the potential for human and mechanical error. This puts emphasis once again on the level of training required, and the need for conversations such as those that take place at the Water Safety Forum. This is, for the most part, uncharted territory – new systems, new technologies, new expertise. The NHS may be facing a complex task, but it’s not an insurmountable one, and the scale of the challenge didn’t undermine the optimism of the discussion among the experts at the Forum. Instead, there was a broad consensus that water safety and the move to Net Zero can work together in harmony, and even achieve a symbiotic relationship where they support one another. To do this, however, the service will have to devise a


complex solution to meet a complex problem, one which draws together teams and expertise from across the NHS. Solutions for carbon reduction, and the resulting necessary changes to water infrastructure and policy will require new standards of competence for everyone, and that means everyone needs a say in how they’re shaped.


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