GUIDANCE
issued following the death of neonatal patients due to waterborne infections with Pseudomonas aeruginosa, quite rightly laid responsibility for water safety within a multidisciplinary team which included Infection Control. With Legionella, which is mostly about engineering controls (not exclusively), the private sector was able to step in and deliver risk assessments and training. With P. aeruginosa and allied organisms this is more about how a range of staff interface and risk assess water/wastewater services. This is ideally the province of Infection Control personnel, who provide cascade training to other staff groups. The private sector was unable to support the training requirements, and thus a significant knowledge gap has been allowed to develop. A key message when issuing guidance is that if it is to be successful, there needs to be accompanying training, and staff need to be competent.
Important caveats In summary, guidance (all guidance relating to design, construction, commissioning, not just the HBN and HTMs) is a necessary component, but should come with important caveats on how it is used. Through better understanding of its purpose and limitations users must realise that chasing compliance with guidance as the end-goal when handing over a new- build has not, and will not, deliver safe and cost-effective buildings. A change of culture is required whereby a risk-based approach is taken, supported by evolving guidance. Without the accompanying essential change in culture to a risk-based approach, it would be wrong to consider guidance even as a minimum standard. If there were need for proof, the evidence is abundant. It is not just the number of projects which make the headlines, but the many others which lead to patient harm (often unrecognised) and significant financial loss. Every stakeholder in a new project needs to understand that being compliant with guidance alone is insufficient to the delivery of key objectives, including – most importantly – patient safety.
References 1 Processes for managing and reporting derogations from estates technical standards and guidance. NHS England. 6 July 2023.
https://tinyurl.com/3edrhbtr
2 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 Infect Control 2017; 6:59.
3 Health Technical Memorandum 04-01: Safe water in healthcare premises. Part C: Pseudomonas aeruginosa – advice for augmented care units. https://tinyurl. com/52ewbcy6
George McCracken
George McCracken joined the NHS in 1993 as a hospital engineer in Down Lisburn Trust, before this working in industry – in cable manufacture and foundry works. In 2002 he moved to the Royal Group of Hospitals, Belfast as a senior engineer, before in 2007 being appointed head of Estates Risk and Environment in the new Belfast Health and Social Care Trust, one of the UK’s largest NHS Trusts. He holds a First Class Honours Degree in Construction Engineering & Management, is a Chartered Member of the Institute of Building, and a member of IHEEM. He currently leads a Risk Team that ‘continues to provide an innovative approach to the management of risk within a healthcare estates environment’.
Susanne Lee
Dr Susanne Surman-Lee, Hon. FRSPH, FRSB, CBIOL, FIHEEM, FWMSoc, FPWTAG, is a Consultant Clinical Scientist specialising in public health microbiology, and a Director of Leegionella Ltd, an independent public health consultancy specialising in the detection and prevention of waterborne disease. A member of the Healthcare Infection Society, the Infection Prevention Society, and the Central Sterilising Club, she is also a Liveryman of the Worshipful Company of Plumbers, and a member of the WCOP Educational and Technical Committee member.
Dr Michael Weinbren
Dr Michael Weinbren is a Consultant Medical Microbiologist, a Specialist advisor for microbiology to the New Hospital Programme, and Chair of the Healthcare Infection Society Working Party on water/wastewater.
Jimmy Walker
Jimmy Walker PhD, BSc, is a microbiologist with over 30 years’ experience in water microbiology and decontamination. He previously worked for Public Health England, managing a range of projects on biofilms and pathogens such as Legionella spp., Pseudomonas aeruginosa, and Mycobacteria spp. He has worked with the Department of Health and the Health and Safety Executive in writing and developing national and international guidance on the microbiology of water and decontamination in healthcare. On leaving PHE he established his independent consultancy, Walker on Water. He is currently the Chair of the Central Sterilising Club. Jimmy and colleagues have recently published their new book entitled ‘Safe Water in Healthcare – a practical guide for the non- expert’, with illustrations and photos.
Dr Manjula Meda
Dr Manjula Meda is a Consultant Clinical Microbiologist and the Infection Control Doctor at Frimley Health NHS Foundation Trust. She is also the current Honorary Secretary to the Healthcare Infection Society. A collaborator on many projects with the University of Surrey and the UKHSA, she is actively involved in supporting clinical research in the Trust’s hospitals. She has a special interest in infection prevention and control in the built environment, and has been involved in leading the management of major infection prevention incidents and outbreaks in healthcare.
Dr Teresa Inkster
Dr Teresa Inkster is Consultant Medical Microbiologist at NHS Greater Glasgow and Clyde, with an interest in the built environment.
October 2023 Health Estate Journal 35
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