INFECTION PREVENTION AND CONTROL


Tackling hospital drainage systems to minimise risk


Here, in the third in a series of articles running in HEJ this year on hospital wastewater systems, Steven Van De Peer, an Authorising Engineer (Water) at Tetra Consulting, discusses what he believes are ‘some of the opportunities for the UK to lead in such systems’ design’. He warns that the only way to eliminate the risks associated with drainage systems in the healthcare environment is to entirely remove the services.


I should begin this article by emphasising that the potential solutions put forward in the piece have not been trialled, and are intended to encourage further consideration of how to tackle some of the problems and issues around healthcare water systems.


Design There are many potential design issues with modern (and older) drainage systems from an infection control perspective, and – as with all risks – we must first discuss elimination, before we move on to reduction and so on. The only way to eliminate the risks associated with the drainage systems in the healthcare environment is to entirely remove the services, including the drainage services, along with the sanitaryware and the water supply pipework. In very high dependency and high-risk environments, it may be beneficial to reduce the number of handwash stations and water services in general to the lowest possible number, while also ensuing that there is a strong design strategy in place that identifies the best placement for handwash stations and other water services within a ward area, ensuring that the proposed activity within the space is the driving factor.


Adoption of HBN guidance HBN documents currently create an issue with regard to the adoption of water-free / minimal water care. These documents are often quoted by designers and operational staff. Patient safety must be at the heart of design, and as such, with antimicrobial resistance approaching, the total adoption of documents like the HBNs needs to be curbed, and a more focused approach to clinical design implemented. The removal of services to a practical minimum will actively remove potential contamination reservoirs within a ward area, thereby limiting the retrograde contamination that is possible. This also benefits maintenance, space allocation, and the general practice as regards particular outlets, as there are fewer available, potentially leading to very specific uses.


World’s first ‘water-free care’ ICU A scientific paper published in 2017 in Antimicrobial Resistance and Infection Control1


have a significant impact and saving on design / construction. In terms of risk reduction, the


segregation of drainage systems is a concept that must be evaluated and heavily considered within the healthcare environment, although it is likely to only be a concept that could be applied to refurbishment and new construction, rather than retrofitting into areas currently in use.


Drainage systems containing faecal matter Any drainage system that contains faecal matter should be heavily considered for segregation from all other drainage systems. It may be beneficial to create separate drainage systems in the following categories: n Faecal waste. n Clinical handwashing and shower drains (perhaps further segregating high dependency / high risk areas).


described what was said to be the


world’s first water-free care ITU (see Figure 1). This was not a new-build designed for water-free care, but a refurbishment. With the New Hospitals Programme underway, if ITUs were to consider the benefits of water-free / minimal water care, this may


n Kitchens. n Clinical process. n Other uses.


In this way, the drainage systems would be entirely separate, and not connected in any way, apart from at the point of entry to the main sewer. This will not eliminate all


Figure 1: An article in the scientific journal, Antimicrobial Resistance and Infection Control in 2017 described what was reportedly ‘the world’s first water-free care ITU’. On the right, inside the ITU room. This was not a new-build designed for water-free care, but a refurbishment. Steven Van De Peer argues that with the New Hospital Programme underway, if ITUs were to consider the benefits of water-free / minimal water care, this may have a significant impact and saving on design / construction.


June 2023 Health Estate Journal 47


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