INFECTION PREVENTION AND CONTROL
Figure 3: Sinks with a rear drain (above) minimise the risk of dispersal of wastewater organisms when an outlet is run, while drains at the base of the sink – especially when hit directly by water from the outlet – are at high risk of dispersal of drain organisms. Work by UKHSA has shown that when drainage of a rear drain is impaired, wastewater organisms are dispersed. The items on the sink ledge were removed from the waste trap of this rear drain sink. Impairment of drainage is relatively common, as rear drains often lack a sieve. While sieves are available, they are rarely
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the drainage systems should be a topic to be discussed. The handover process for drainage should (as with most other systems) include the delivery of an O&M manual describing the systems that have been installed, the manner in which they have been installed, the intended purpose and design intent, the correct operation of the systems in relation to the design, the correct maintenance practices to
any maintenance access points, and any relevant commissioning data. The drainage systems should also
ideally be ‘witnessed’ by key stakeholders, and the main design concepts discussed; in this way the systems can be seen in person, questions can be raised, and those that will have responsibility for the systems’ day-to-day management will understand the basic layout and operation concept.
Occupation and ongoing maintenance Once the wastewater system is in use, it is important to make sure that all users are made aware of the intended use of the basin / sink. This is predominantly an education issue, but may be assisted
while in newer building designs, different- coloured IPS panels could be considered to create a colour-coded approach to usage. Effective planned maintenance of wastewater systems requires considering regular monitoring with cameras in predetermined locations following a risk
ensure that the systems are kept free from debris long term to prevent large-scale blockages. Blockage-clearing equipment storage
should be considered in line with a risk assessment that considers IPC. The
50 Health Estate Journal June 2023
movement of this equipment through the hospital environment, and its potential cleaning and disinfection, are also key considerations – the means for which should be established and reviewed. Response times to blockages should
be carefully considered, not just on the severity of the blockage, but also the location. A big blockage that has seen an X-Ray department completely blocked needs a rapid response, as indeed would a blocked sink in an augmented care ward. Both the operational impact and the risk to patients need to be considered when applying appropriate response times to maintenance activities. The process of returning basins/sinks
back to normal use will require thought, as a blockage dramatically increases surface contamination, and when the blockage
need to be disinfected to avoid further retrograde contamination of the area and protect the water systems.
Communication to staff The communication of the various risks to all staff that interact with the drainage system or provide care is an element that is severely lacking. The potential problems associated with healthcare wastewater infrastructure require awareness at all levels, in all departments, right across the sector. There needs to be a bigger and more inclusive engagement programme across the NHS regarding AMR, with the drainage system risks on the agenda – from design, right through to ongoing interactions. The UK has the opportunity to save thousands of lives and lead the way in new hospital design framed around AMR and patient safety, and indeed the New Hospital Programme, and the sector as a whole, must take account of the risks posed by drainage in healthcare to drive
new practices and innovation at industry level, or the price could be very high indeed.
Reference 1 Hopman J, Tostmann A, Wertheim H, Bos M, Kolwijck E, Akkermans R et al. Reduced rate of intensive care unit acquired gram-negative bacilli after removal of sinks and introduction of ‘water-free’ patient care. Antimicrob Resist and Infect Control 2017; (6)59. DOI 10.1186/s13756-017-0213-0
Steven Van De Peer
Steven Van De Peer EngTech, TMIET, MWMSoc, AMIHEEM, is an Authorising Engineer (Water) at Tetra Consulting, with a history of working in the construction and facilities management industries since 2005, across multiple sectors, including healthcare, education, government, and commercial. He has extensive experience in domestic, evaporative cooling, spa, and swimming pool water systems.
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