WATER HYGIENE AND SAFETY – SPECIAL REPORT


carefully) for patient en-suite bathrooms. This has led to increasingly complex problems with microbiological water quality, which have tended to be met with more and more complex taps and flushing systems, leading to a circle more vicious than virtuous. While I would not advocate reducing sanitaryware to the extent that there are queues for handwashing, or significant reduction in patient privacy, when I am presented with a hospital where 25% of the outlets have been deemed to be infrequently used, I believe we are failing by accepting this, and meekly putting flushing in place for all of those outlets. However, there are instances where flushing is necessary to remove stagnant water, but one would expect this to be a short-term measure, for a limited number of assets. It is a necessary evil.


References 1 HM Government, 1999. The Water Supply (Water Fittings) Regulations.


2 Hill NP. A vital role in keeping water systems safe. Health Estate Journal 2017; 71 (2): 33-8.


3 Department of Health, 2016. Health Technical Memorandum 04-01: Safe water in healthcare premises. Part A: Design, Installation, and Commissioning.


4 Hill NP. Large buildings can deliver cold water in a heatwave. Health Estate Journal 2018; 72 (9): 57-61.


5 Department of Health, 2016. Health Technical Memorandum 04-01: Safe water in healthcare premises. Part B: Operational Management.


6 Department of Health, 2016. Health Technical Memorandum 04-01: Safe water in healthcare premises. Part C: Pseudomonas aeruginosa – Advice for Augmented Care Units.


7 Department of Health, 2006. Health Technical Memorandum 04-01: Safe water in healthcare premises. Part B: Operational Management.


8 NHS Estates, Department of Health, 1993. Health Technical Memorandum 2040, Operational Management, The control of legionellae in health care premises – a code of practice.


9 Health and Safety Executive, 2014. HSG 274. Legionnaires’ Disease. Part 2 – The control of Legionella bacteria in hot and cold water systems.


10 Dondero TJ Jr, Rendtorff RC, Mallison GF et al. An outbreak of Legionnaires’ disease associated with a contaminated air conditioning cooling tower. N Engl J Med 1980; 302 (7): 365-70.


11 Den Boer JW, Yzerman EPF, Schellekens J et al. A large outbreak of Legionnaires’ disease at a flower show, the Netherlands, 1999. Emerg Infect Dis 2002; 8 (1): 37-43.


12 Makin T, Hart CA. The efficacy of control measures for eradicating legionellae in showers. J Hosp Inf 1990; 16 (1): 1-7.


Dr Nick Hill


Dr Hill BSc, MSc, MBA(Oxon), PhD, DIC, CBiol, MRSB, FIHEEM, is a Fellow of IHEEM, and is the former Chair of the Institute’s Water Technical Platform. He sits on the IHEEM Authorising Engineer (Water) Registration Board. He has been employed by a water authority, on corrosion research, undertaken research at a sewage works, and worked for an industrial water treatment company. Thereafter he served as an independent consultant, advising organisations on borehole feasibility, process water treatment, wastewater minimisation, groundwater contamination, effluent treatment, drinking water treatment, and water quality troubleshooting, etc. He has worked in 25 countries, on all continents except Antarctica.


For many years he has advised clients about water in buildings, including hej


on Legionella and Pseudomonas aeruginosa. He also addresses the issues associated with wastewater, and particularly antibiotic-resistant microorganisms. His current workload is dominated by assisting clients to avoid potential problems through the encouragement of good design, installation, and commissioning, and troubleshooting existing water systems which have persistent microbial contamination, using data analysis and root cause investigations. Nick Hill serves public service organisations and blue chip companies as a consultant. His role at Water Quality London includes acting as Authorising Engineer (Water), and consultant and expert witness for organisations which manage properties and their water/wastewater systems in London. He also presents training courses for Water Safety Groups, Responsible, Authorised, and Competent Persons. He served on the Department of Health’s Working Group for the production of HTM 04-01(2016), Safe Water in Healthcare Premises.


13 Mampel J, Spirig T, Weber SS et al. Planktonic replication is essential for biofilm formation by Legionella pneumophila in a complex medium under static and dynamic flow conditions. Appl Environ Microbiol 2006; 72 (4): 2885-95.


14 Piao Z, Sze CC, Barysheva O, Iida K, Yoshida S. Temperature-regulated formation of mycelial mat-like biofilms by Legionella pneumophila. Appl Env Microbiol 2006; 72 (2): 1613-22.


15 Lehtola MJ, Laxander M, Miettinen IT, Hirvonen A, Vartiainen T, Martikainen PJ. The effects of changing water flow velocity on the formation of biofilms and water quality in pilot distribution system consisting of copper or polyethylene pipes. Water Res 2006; 40: (11), 2151-60.


16 United States Environmental Protection Agency, 1992. EPA/625/R-92/001. Seminar Publication: Control of Biofilm Growth in Drinking Water Distribution Systems.


17 Fish K, Osborn AM, Boxall JB. Biofilm structures (EPS and bacterial communities) in drinking water are conditioned by hydraulics and influence discolouration. Sci Total Environ 2017; 593 (4): 571-80.


18 Tsvetanova Z. Quantification of the bacterial community of drinking water- associated biofilms under different flow velocities and changing chlorination regimes. Appl Wat Sci 2020; 10: 3. 19 European Society for Clinical


Microbiology and Infectious Diseases (ESCMID), Study Group for Legionella Infections (ESGLI), 2020. ESGLI Guidance for Managing Legionella in Hospital Water Systems During the Covid-19 Pandemic, 20200409 v 1.00, 8pp.


20Zhou F, Yu T, Du R et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 2020: 395 (10229): 1054-62.


21 European Society for Clinical Microbiology and Infectious Diseases (ESCMID), Study Group for Legionella Infections (ESGLI), 2020. ESGLI Guidance for Managing Legionella in Nursing and Care Homes During the Covid-19 Pandemic, 20200603 v 3.00, 6pp.


22 European Society for Clinical Microbiology and Infectious Diseases (ESCMID), Study Group for Legionella Infections (ESGLI), 2020. ESGLI Guidance for Managing Legionella in Dental Practices During the Covid-19 Pandemic, 20200424 v 01.01, 5pp.


23 European Society for Clinical Microbiology and Infectious Diseases (ESCMID), Study Group for Legionella Infections (ESGLI), 2020. ESGLI Guidance for Managing Legionella in Building Water Systems During the Covid-19 Pandemic, 202000603 v 3.00, 4pp.


24 HM Government, 2002. The Control of Substances Hazardous to Health Regulations.


December 2020 Health Estate Journal 13


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