WATER HYGIENE AND SAFETY – SPECIAL REPORT


Table 1: Examples of findings from investigations into cases and gross contamination incidents.


n A nursing home where the contractor was on the brink of going out of business, so used poor quality copper, which resulted in pitting corrosion and flooding within months of the building opening; in addition, to save money, the hot water supply was on a long spur system with no returns.


n A theatre block where there were TMVs fitted before thermostatic mixing taps; these were fitted behind panels so their presence was unknown. TMVs pose an inherent risk from colonisation (paper in preparation).


n Filling of a new water system fitted with a POE filtration system; the POE was bypassed when the system was filled.


n Using external subcontracted plumbers to meet a handover deadline who used hemp when fitting a main cold-water distribution pipe – the whole undercroft had to be replumbed.


n A new hot water system with an expansion vessel, which could not be drained, adjacent to the hot water heater in the plant room.


n Recent design plans for a new plant room included cold water storage tanks to be fitted without any separation from the hot water heaters.


n A cardiology building which was designed to have a chlorine dioxide treatment plant, which was in the plans, but not fitted by the contractor.


n Isolation valves on each outlet used for balancing the system – resulting in a system impossible to balance, and wide variations in water temperature across the building.


n Cold, hot, and steam services in the same riser in a new cardiothoracic unit without adequate insulation, and requiring mechanical ventilation.


n Hot and cold-water pipework in a tower block riser tied with metal fixings across the pipework, resulting in heat transfer from hot to cold increasing the cold- water temperature significantly above 20˚C.


n A plumbed-in drinking water dispenser with the copper supply pipework plumbed directly above an electrical socket (see Fig 4).


n It goes without saying that there have also been the inevitable deadlegs and ‘blind ends’, including those rising over several storeys.


understand the root cause of the problem, samples were taken from every hot and cold outlet, and revealed that almost 40% of the outlets were positive, with many outlets not being used enough for control measures to be effective.


Lessons learned


This building was designed based on an excessive estimate of consumption at 13 m3


of water per day, when in reality actual consumption is closer to 5 m3


.


This problem is common, mainly due to overprovision of outlets; however, the ability of patients to use outlets must also


Make Yo DFA


be considered, especially in a building where the majority of patients are too ill or immobile to use showers and outlets. This is something that architects and design engineers need to take into account when designing water systems. The remedial actions had to be completed in an intensely busy clinical environment with limited access to patient rooms. Good partnership working and clear communication between the Estates team responsible for water safety, and the clinical and cleaning teams on the ground, was critical. It was primarily through successful partnership working


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that the substantial programme of remedial works was successfully managed, while maintaining essential clinical services. The importance of ensuring that such a close working relationship is developed and maintained between clinical, estates colleagues, and cleaning staff (in this building the sink cleaning protocol includes routine flushing), cannot be overstated.


‘As-fitted’ drawings


Having a complete and accurate understanding of the nature and location of plumbed services is essential to determine all points identifying risk, or when there is a failure within the system. This Trust engages qualified plumbers to verify the accuracy of the water system drawings provided at building handover, as they have the trade knowledge of pipework types and runs. The use of accurate drawings is extremely important when plotting the location of positive results, to pinpoint the root cause and assess potential patient impact.


Risk assessment


The need for a robust risk assessment is probably the most misunderstood element when managing a complex water system. Risk assessments assist with not only identifying hazards, but also to support decisions as to how and why remedial actions are prioritised. Another element which was uncovered during the risk assessment process was that system balancing, across all four floors, had been completed using the ‘balofix’ isolation valves for each outlet. When these valves were fully opened, large amounts of brown, stagnant water were discharged. It became very clear not only that a substantial amount of work needed to be completed to achieve properly balanced circuits, but equally that there was no evidence of system balancing at the time of commissioning. When this question was then raised on other projects, the lack of design knowledge on how to design a system that can be properly balanced was very evident.


ca :all • email: info@recorduk.co.uk • www.recorduk.co.uk December 2020 Health Estate Journal 25

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