WATER HYGIENE AND SAFETY – SPECIAL REPORT


not used day to day. Equally, the way we engage with staff is important. Telling domestic staff to ‘do this or not do that’ without any explanation is unlikely to embed practices. However, explaining to staff what the risk is, how their actions could result in a neonate developing sepsis, and their important role in protecting patients alongside medical and nursing staff, is much more likely to result in compliance. For example, see the following link of a recent study, where a video camera placed over an ITU handwash station showed that only 1 in 25 visits were for the correct purpose – handwashing. (https://www.youtube.com/watch?v= v27WAY9J8_4&feature=youtu.be). There are a number of ways in which handwash stations may become contaminated due to human factors – including where materials such as fluids, medical products, and foods, are discarded into the sink, providing an environment akin to a microbial fermenter in the drain traps, and resulting retrograde contamination back into the handwash station (Fig 6).


While not designed for the purpose, the area surrounding the handwash station may be used as a shelf, or for disposal of a wide range of fluids secretions. In addition, the positioning of the water t ap lever can also lead to contamination via the inability to operate the lever appropriately (Fig 7).


External contractors


It is commonplace to use many external contractors on hospital sites, and their competency and infection control practices need assessing beforehand. Simply reviewing their Standard Operating Procedures is insufficient; it is essential that their work is observed and audited while they are on site. Taking water samples for microbiological testing is a practice often undertaken by external contractors. How the sample is collected is critical to getting the right result, but such staff are frequently not trained in correct practices. If pre-flush water samples are being collected on your hospital site, and the contractor is not agreeing a plan with the wards in advance of their arrival, it is highly unlikely that the correct samples are being collected. Have you audited this?


The periphery of the water system is an area we are still learning about. HTM 04-01 is principally concerned with P. aeruginosa, although a wide range of other organisms may take advantage of this arena to cause infection.4


Control of


transmission requires a holistic approach, and is not a matter of water testing alone. P. aeruginosa risk assessments currently revolve principally around testing and engineering controls. However, the way staff interact with the periphery of the system is critical in minimising risk, and


20 Health Estate Journal December 2020


Figure 7: Inappropriate use of a handwash station, with utensils placed on ledges, and poor positioning of the hand lever.


expertise and training in this area need developing. A British Standard on P. aeruginosa risk assessments is currently in development. Ward staff naturally see a handwash station as a place of safety, and are not always aware of the risks to patients if that environment is used incorrectly.


Manage your system effectively In conclusion, microbiological problems start to become an issue as soon as water is delivered to your building, and thereafter, unless managed, your water system will become a breeding ground for microbial pathogens such as Legionella, P. aeruginosa, and NTMs. If these waterborne pathogens are not controlled, they can proliferate and endanger at-risk patients in high dependency units. While by implementing a hazard analysis and critical control point approach (often used in the food industry), the hazardous areas in the water system can be identified, the human element also needs consideration; thus implementing a competently trained, multidisciplinary Water Safety Group, supported by an educated workforce, can ultimately lead to a safer water system for patients, staff, and visitors.


This article set out to discuss and demonstrate the barriers to safe water in healthcare, and to describe inherent risks and hazards, including the impact of human factors. We hope this approach has provided a ‘flavour’ of some of the science behind providing safe water, and the challenges that prevent its delivery. We will be using this approach to compile a book on ‘Safe Water in Healthcare’.


If you would like to provide


constructive comments on the contents, we would be pleased to hear from you. Please contact the corresponding author in the first instance, at: jimmywalker@walkeronwater.org


Acknowledgement


The authors did not receive any funding or financial contributions for this submission. Dr Walker would like to dedicate this article to Wilco van der Lugt, a practical engineer with a particular interest in Legionella,25


and to Tina Bradley, a


microbiologist who was always willing to share her time and her expertise.26


“My friends, we will miss your expertise, enthusiasm, and contributions to microbiology.”


He adds:


hej


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