HEALTHCARE WASHROOMS
months change has been more rapid, with non-clinical areas adapting to the urgent demand for critical care. Designing flexibility into the system ensures that, as the usage pattern at the outlet changes, the threat of deadlegs and blind ends is minimised.
Outlets in constant use see regular draw-off of both hot and cold water, but if a run of washhand basins or showers is supplied with pre-mixed water to prevent scalding, a cold water deadleg downstream of the group mixing valve is inevitable, since there is no need to blend the hot water at the point-of-use. If the cold water draw-off is very infrequent, biofilm will establish, leading to bacterial contamination. Any outlet subject to long periods of inactivity should be reviewed and even re-designated – for example removing under-utilised showers, e.g. in critical care areas. This is echoed in the HBN 00-09 recommendation: ‘Consider hands-free operation of utilities (for example, sensor taps, [and] movement sensors for toilet flushes etc).’
Hygienic solutions for infection control
Health & Safety Executive guidance for Legionella control also recommends flushing the system once a week to prevent stagnation. Delabie’s electronic sensor controls provide an alternative to manual flushing – with taps, showers, and even some WC and urinal valves that are pre-programmed to flush every 24 hours after the last use. Dealabie’s electronic controls can contribute to system hygiene in several ways. Battery-operated models are ‘plug-and-play’, and need no electrical connection. The integral solenoid is piston-operated, renewing the water in the valve with every activation, unlike electronic models with a rubber diaphragm, which can trap water and
This stainless steel surgical scrub-up trough offers ‘hygiene and safety benefits’.
become a source of nutrients for bacterial development.
Specifying sensor-controlled urinal and WC flush valves provides hygiene benefits for the user and the system. User hygiene is optimised as there is no manual contact, removing the risk of cross-contamination by hand, while system hygiene is improved as both urinal and WC flush mechanisms rely on water pressure from the system itself, rather than a gravity-fed cistern, to rinse the pan or bowl. Removing the need for a cistern means that there is no water stagnation, scale, or debris build-up – all factors that encourage bacterial development and leaking seals.
An ergonomically designed Securitherm mixer with stainless steel spout and Biofil filter can be operated without manual contact.
80 Health Estate Journal November 2020
Encouraging desired behaviour The second consideration when designing hygienic handwashing facilities is how to ensure the desired behaviour in users. This distils down to where, what, and how many? In all capital projects, location is key, particularly when it comes to infection control. A typical barrier to use is convenience, and healthcare is no exception. Users under time pressure will use the most accessible facility, rapidly establishing automatic behaviour patterns that are difficult to break. If convenience is built in at the design stage, it is easier to establish the desired behaviour from the start. This applies to refurbishment and re-purposing projects, as well as new- builds. HBN 00-09 takes a pragmatic stance, recognising that in clinical areas, less convenient wash stations will be under-utilised, creating a deadleg; therefore, convenience should override bed-to-basin ratios.
Designing for convenience Convenience demands that the facilities are comfortable and easy to use. In each area of activity – whether for clinical or general and ancillary use or for augmented care – the sanitaryware, tapware, and accessories, must be adapted for the appropriate use. For facilities for clinical areas or mental health and learning disabilities, existing guidance (Building Notes and Building Regulations) is very prescriptive regarding dimensions and location. The message in HBN 00-09 is clear: ‘Provide sufficient space for activities to take place and to avoid cross- contamination.’
Ergonomic tap design is therefore vital for hygiene, cleanliness, and infection control. The mixers and taps used for patient en-suite facilities must be suitable for the resident’s physical needs, allowing for correct handwashing techniques to avoid retro-contamination. An increased spout height and projection will ensure that there is no splashback (water should not run directly into the drain). It will also allow for an antibacterial water filter cartridge to be installed should a contamination episode occur.
Consider user needs
Design considerations for convenience and cleanliness can be incorporated in all user areas. Various control options are available depending on the specific needs of the user. Long-lever controls require minimal dexterity, and can be operated by the elbow or wrist. Similarly, elbow or knee-operated controls require no manual contact, and minimise contamination. In certain areas, such as augmented care,
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