HEALTHCARE WATER SYSTEMS
Education Proactive infection control involves moving water safety up the list of priorities for anyone in contact with water systems. Raising awareness of this through education was discussed at length at the Water Safety Forum, with a focus on the breadth of training necessary, and where the responsibility lies in delivering it. This is currently being hampered by a lack of overall responsibility for delivery, and a huge diversity when it comes to job roles, types, and internal structures. When you expand the base of
The Markwik 21+ mixer tap from Armitage Shanks.
at its London showroom to gather their experience in the prevention of waterborne infections, and build a more comprehensive picture of the challenges faced from every angle. Crucially, it wanted to know what role manufacturers can play in championing water safety. Attendees included clinical leads responsible for infection control, water services managers, engineers, contract managers, microbiologists, and scientific writers, alongside innovation and specification representatives from Armitage Shanks.
Richness of data Much of what was shared centred around discovering the scale and nature of the problem, and increasing the amount and richness of data on which interventions are based. Effective sampling of outlets and trend analysis can assist the risk assessment process, but the data received must provide for the range of conditions that affect water safety – simply measuring temperature isn’t always enough. The frequency of sampling also has important consequences for effective responses to infection events. If samples are taken once a month, once a week, or even once a day, there will always be a period where pathogens may slip through unnoticed. Advances in building management systems have allowed some real-time monitoring of basic characteristics, including temperature and flow rate, but these systems are often designed with functionality in mind, meaning infection control is a secondary consideration. To make these systems more effective, hospitals need a better understanding of their own requirements, and this is achieved through the sharing and effective communication of information. Designing and implementing these systems in consultation with WSGs and Infection Control teams would also ensure that systems are properly oriented, with monitoring that has been refined to provide the most valuable data.
30 Health Estate Journal October 2022
A solid foundation for interventions Once collected, this data would then form a solid foundation for interventions, such as allowing WSGs to identify and locate sources of contamination. Ensuring that this data is passed to those with the skills to interpret them is also essential – for example, an engineer might be able to spot a problem that would not be seen by clinical staff, and, conversely, clinical outbreak data may indicate links to the water supply. The need to share information broadly and quickly also emerged in the discussion, with acknowledgement that collaboration must happen at a granular level, as well as on the surface. With effective sampling and forthcoming data sharing comes increased accountability and responsibility. This leads on to the sharing of data with the relevant local authorities and government bodies. The group agreed that active and
comprehensive monitoring and sampling are fundamental to effective water safety planning, but it was also clear that implementing these processes requires a more pragmatic approach to the reality of the situation. When you consider the latest figures that show that around 21% of occupied hospital bed days in England are caused by hospital-acquired infections, identifying and remedying waterborne infections must be a priority.1
However,
when developing an approach to move beyond the current situation, using monitoring and sampling as the starting point will ultimately result in a WSP that is only able to respond to contamination that has already occurred.
Moving to a ‘no blame’ culture Moving towards a ‘no blame’ culture was also a key topic of conversation. Singling out individuals or teams as sources of contamination only sets progress back, with the ‘blame game’ discouraging the type of collaboration that’s central to the success of any measures.
responsibility beyond clinical staff, you quickly encounter new sets of priorities, pressures, and ways of working. Agency staff. for example, may only work in a particular healthcare setting for a short period of time, and at very short notice, and ensuring that these staff have the correct training can be very difficult. Attendees at our Forum spoke of their difficulty ascertaining where the responsibility lies for this training within the Trust/agency relationship, and how future contracts can be updated to reflect this. The unfortunate reality is that extra training is likely to discourage agency staff, particularly in a labour market where demand far outweighs supply.
Making training intuitive Making training as intuitive and practical as possible was also discussed. Clinical staff talked about delivering impromptu training sessions to try to quickly establish positive habits, including explaining the ‘one sink = one cloth’ rule used to prevent transfer of pathogens. Another attendee described using glow gel to demonstrate to maintenance staff how pathogens can be transported from one site to another on hands and tools. Making sure that this issue is front of
mind for cleaners, engineers, specifiers, and designers, often relies on linking the small actions they can take to prevent contamination with the tangible health benefits of reducing the burden of hospital-acquired infection. Training and education programmes should not simply mandate how staff should practice proper hand hygiene or carry out water- related tasks, but make clear why these interventions are more than just another item on their checklist. Hospitals and healthcare settings need to be established as exceptional projects and tasks, for all stakeholders, to ensure that water safety is taken seriously. One important element of the discussion was the need to provide education on the complexity of water safety as an issue, and just how much there is to consider at the design and construction stage.
The beginning of the design process Returning back to the very beginning of the design process was another major
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