WATER SYSTEM HYGIENE & SAFETY
regime, and via speedy analysis of results. we will reduce microbial biofilm formation within healthcare facilities’ domestic water system, providing much safer environments for all. We recommend that a review of the
HTM issued in 2016, specifically for P. aeruginosa (including Nontuberculous mycobacteria sampling regimes/plans) be considered to enable a more robust and practical approach to be adopted. The HTM guidance, and BS 85802:2022, do not currently align in all aspects of the recommendations. Given that clinical vigilance, and ongoing risk assessment reviews in healthcare, are the basis upon which we strive to have a safe environment for patients and staff, on what basis was six-monthly sampling for Pseudomonas aeruginosa decided upon in current guidance?
Scale build-up on a tap.
HTM 04-01 of undertaking sampling at birthing pools for P. aeruginosa bacteria. HTM 04-01 Part B, section 1.12, directs you to ‘birthing pools’. See also HBN 09-02 – Maternity care facilities, and the Pool Water Treatment Advisory Group (PWTAG’s) Swimming pool water: treatment and quality standards for pools and spa. Unfortunately, there is no mention of water sampling regime in this guidance.
Pseudomonas aeruginosa risk
assessment should be continuously reviewed and updated by the Infection Prevention and Control team, while Water Safety Group meetings should provide support to assess the sampling frequency to reflect patients’ needs and safety. Sampling of high-risk areas every six months is not sufficient to capture early signs of P. aeruginosa bacteria contamination within a domestic water system, and, in the process, allow early intervention to reduce the risk of biofilm growth. Biofilm is of course extremely difficult to remove, and presents a high risk of contamination of domestic hot and cold water systems and the environment (splashing of contaminated water), reducing greatly the ability to maintain water quality to the higher microbiological standards required in augmented care wards.
Early detection key Early detection of microbial contamination, and the speed with which we act to remove or control it, are the key elements here. This information will trigger initial action to chase the contamination out of the system. The quicker we know, the quicker we can act and return outlets to clinical use without point-of-use filter installation (pending clinical risk assessment of course). The Health & Safety Executive and HTM requirement is to maintain vigilance on water quality,
46 Health Estate Journal March 2024
and to ensure that microbial levels are managed, and – where possible – eliminated in a healthcare environment. It would be more practical, time, and cost-effective overall to ensure that all healthcare facilities have in place building water sampling facilities on site to allow speedy delivery of water analysis results, providing a quicker means of identifying waterborne pathogen contamination.
Improving in-house sampling technologies In-house sampling technologies have improved greatly, and there are several options open to us, allowing us to use the facilities to our advantage in conducting speedy remedial works, eliminating prolonged waiting times for analysis to return to the Water Safety Group and Infection Prevention and Control teams to review and agree upon correct remedial action. By adopting the correct sampling
Karina Jones
Karina Jones FIHEEM, MWMSoc, MWES, MIET, has many years’ experience in water management, working closely with NHS Trusts and water management companies maintaining her role as an IHEEM registered Authorising Engineer, who provides independent and impartial advice to clients across a wide range of challenges in this specialised industry.
She has extensive experience providing advice on water hygiene management, advising clients on the legal drivers for statutory obligations and ACOP L8 compliance, and providing comprehensive guidance on microbiological waterborne contamination in water systems to major NHS Trusts across the country.
Karina is a strong advocate that Authorising Engineers should not only highlight areas of non-compliance, but should also support clients towards effective solutions. She is a Fellow of the Institute of Healthcare Engineering and Estate Management (IHEEM), a member of the Institution of Engineering and Technology (IET), and a full member of the Water Management Society (WMSoc). She is also an active member of IHEEM Water Technical Platform and the Women’s Engineering Society (MWES).
References 1 The Regulation and Quality Improvement Authority. Independent Review of Incidents of Pseudomonas aeruginosa Infection in Neonatal Units in Northern Ireland. Final Report 31 May 2012.
2 HTM 04-01 Safe Water in Healthcare Premises. HBE.
https://hberm.com/safe- water-in-healthcare-premises-htm-04-01/
3 The Approved List of biological agents. Advisory Committee on Dangerous Pathogens. Fifth edition, 2023. https://
www.hse.gov.uk/pubns/misc208.pdf
4 Pseudomonas aeruginosa. Wikipedia.
https://en.wikipedia.org/wiki/ Pseudomonas_aeruginosa
5 HTM 04-01: Safe water in healthcare premises Part B: Operational management. Department of Health. 2016.
6 Newborn services – neonatal unit – information published online. St George’s University Hospitals NHS Foundation Trust.
https://www.stgeorges.nhs.uk/ service/childrens-services-2/neonatal/
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68 |
Page 69 |
Page 70 |
Page 71 |
Page 72 |
Page 73 |
Page 74 |
Page 75 |
Page 76 |
Page 77 |
Page 78 |
Page 79 |
Page 80 |
Page 81 |
Page 82 |
Page 83 |
Page 84 |
Page 85
