WATER SYSTEM SAFETY
not assume that they understand all factors leading to the ingress, growth, and persistence, of target organisms other than legionellae. The Responsible Person (RP) / Water Safety Group (WSG) should satisfy themselves that all those involved in the risk assessment process have the information and competence to undertake a ‘sufficient and suitable’ assessment of the risks from all relevant hazards, and that the risks are evaluated properly. While Legionella risk assessments are usually undertaken by an individual, a Pseudomonas risk assessment requires input from a range of individuals with varying expertise, and should be undertaken by a multidisciplinary team to verify that all relevant hazards, hazardous events, systems, and relevant equipment, are assessed – including the way water- containing or storage devices are used, plus all potential modes of transmission, and the susceptibility of those likely to be exposed.
Many potential infection pathways There are many potential infection routes in healthcare settings, including directly from person to person, and indirect transmission from person to water system components, and then onwards to other people. This is largely an infection prevention and control issue. Directors of Infection Prevention and Control (DIPCs) (or those who take on the role) have authority and responsibility for ensuring that strategies are implemented to prevent avoidable healthcare-associated infections across their healthcare organisation. The multidisciplinary team, as recommended by BS 8580-2, should surely be chaired by the DIPC, who will have a controlling input? This team is like a Water Safety Group, and could be designated as a WSG sub-group with individual terms of
The Pseudomonas outbreak in 2012 within the neonatal unit of the Royal Jubilee Maternity Hospital in Belfast (pictured), in which three babies died, highlighted the problems associated with the organism.
reference for members, detailing their roles and responsibilities. Whatever the decision, it should be clear who is leading the risk assessment process, and who should be involved in each step, i.e. who will be carrying out an assessment of exposure risks, assessing the susceptibility of those exposed, undertaking the engineering and physical water system design and operation and environmental services practices (e.g., cleaning and maintenance), and reviewing, monitoring, and collating the surveillance data, and writing the report.
Competent assessors Assessors – whether ‘in-house’ or external – should have experience of the type of premises and/or equipment being assessed, and be familiar with and understand the requirements of the relevant standards and guidance applicable to PA risk assessments. Assessors need to have the skills and competencies to identify the factors leading to the ingress, colonisation, and growth of PA, and be aware that infections can originate not just from water distribution systems and the surrounding environment, but also from specialised systems and associated equipment, such as within dental practices, decontamination units, hydrotherapy pools etc., and above-ground wastewater systems.
BS 8580-2 is especially applicable to all types of healthcare premises, including hospitals, care, and residential homes.
Specialist input Specialist input should be sought by assessors where required, for example from: a) Specialist service-providers, where risk assessments are needed for those using systems or equipment which use non-sterile water. The input of users of the
equipment is essential – for example ward managers in augmented care, aquatic therapists and pool plant operators in hydrotherapy pools, and representatives from dialysis, decontamination, special needs and mental health, dental services, and medical physics. b) Non-specialist service-providers, such as those undertaking, supervising, and managing, cleaning and other housekeeping/maintenance work. c) Infection prevention and control staff with knowledge of the at-risk ward/unit areas, surveillance data, and at-risk patient groups. d) Medical and clinical microbiologists holding data on clinical surveillance and the prevalence of antibiotic-resistant strains. e) Authorising Engineers (Water)/ independent advisors.
Risk assessment – the preparation, appraisals, and checks Assessors should contact the ward/area before undertaking the risk assessment to gather background information, such as the type of patients being treated, and their susceptibility / vulnerability, the systems and equipment in place, procedures carried out, and how they use water. A pre-assessment questionnaire could be issued to the ward/area manager before the visit takes place to gather this data. With this initial data, the risk assessment team should contact all other relevant service teams, for example Estates, Facilities, Medical Physics, Physiotherapy, and Patient Support Services such as cleaners, catering etc., to gather preliminary information, such as the existing Legionella risk assessment, and maintenance associated with either equipment that uses/stores, or is cleaned
June 2022 Health Estate Journal 25
Courtesy of the bsi
Courtesy of the Belfast Health and Social Care Trust
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