WATER HYGIENE AND SAFETY – SPECIAL REPORT


Mechanical interventions When showers returned positive results, the Trust turned to new technology. New showers were fitted, which can be programmed to flush at set intervals if they have not been used manually within a preset time frame. Data recovered through the BMS was able to identify which outlets were used, and which needed flushing automatically. The results were quite startling, demonstrating just how little some outlets were being used. The use of technology through design is something that needs to be embraced to allow services to be offered and maintained safely, even when infrequently used. It is pleasing to note that there have been no positive results returned since January 2020.


Ensuring safer water provision The range of competencies required to ensure that all water is safe for its intended uses and users within hospitals (where there are many uses of water over and above those detailed within drinking water legislation – for example decontamination of instruments, aquatic therapy, dialysis, pharmacy preparations etc – and where the population at risk is more susceptible to waterborne infection) is too great for one discipline alone to deal with. The complexities of providing safe water for all the specialist uses within the hospital environment necessitates expertise in both water microbiology and water chemistry, and an understanding of the relevant standards, hazards, hazardous events, and appropriate control regimes, for each type of use. The prevention of antibiotic resistance is a major global challenge, and of increasing concern to infection prevention and control (IPC) professionals. It is only fairly recently that the link between poor sink design – leading to splashing, poor cleaning techniques, poor drainage and management, together with the use of sinks as disposal vessels, has been linked to the acquisition of microbial resistance and patient infections.10


The sink drain


plays an important role in providing an ideal environment for antibiotic resistance transfer.11


As a consequence, it is not just the distribution of safe water that needs to be considered, but also the design of safe drainage to prevent waterborne infections.11,12


Little formal training for IPC staff As observed by Weinbren in 2020,13


there


is little in the way of formal training for IPC staff in the implications of poor building design, especially when their remit covers not just water safety, including drainage, but also the physical environment, prevention of cross-contamination of infectious agents, decontamination, and ventilation etc., and there are very few infection prevention and control


26 Health Estate Journal December 2020


water system and air-conditioning maintenance personnel, experts in decontamination and disinfection, independent specialist advisers/ Authorising Engineers,6


and


representatives from specialist user groups. It is essential that such a team is empowered and kept informed, and aware of any factors which may affect the risk assessment and management plan and increase the risk of waterborne infections.


Uninsulated pipework behind a panel in a new build.


professionals who have the experience and competencies required, never mind the time away from their day job, to carry out this role. It is not realistic therefore, as some have suggested, that infection prevention and control professionals, without specialist training themselves, should be involved in both the training of engineers, architects, and others involved in the design and build process,6,14


and be


actively involved from the initial concept of the building with site visits to reduce the risk of hospital-acquired infections, including those derived from water.15,16


Value of a Water Safety Group In healthcare premises, the identification of all related hazards can be a difficult and complex process, as there are many potential routes of exposure, not just from distributed water for drinking, cooking, and bathing etc., but also via the many different uses of water, including that used for patient diagnosis and treatment. The recommended approach is to appoint a team (a Water Safety Group (WSG)) with all the skills and competencies needed to manage all water-related risks on site. This team should include personnel working at the premises, i.e. familiar not only with the water systems, equipment etc, and the water quality and management, but also the particular vulnerabilities of the ‘at risk’ population within the facility. Other WSG members may include medical doctors, nurses, infection prevention and control specialists, microbiologists, engineers,


An improving outlook


The outlook appears to be improving: in May this year the British Standards Institution published BS 8680:-Water quality – Water Safety Plans – Code of practice,17


which details how an


organisation can develop a holistic WSP taking into account all potential hazards, and manage the risks effectively from the concept stage onwards. There is much good guidance within this BS 8680 on how to ensure that the design and build process minimises risk, and it is to be hoped that the new standards alluded to by government will take account of the recommendations within this standard. It should be acknowledged that there is a global issue with the construction industry (not restricted to healthcare). Significant issues with new builds are common, and rarely reported, producing a situation perpetuating mediocrity. However, the Scottish Government has taken a major step forward to address the issue. In response to major issues in new hospital builds in Glasgow and Edinburgh, it has supported the establishment of a Scottish Centre whose aim is ‘To be an internationally recognised national centre for reducing risks in the healthcare-built environment’.


Acknowledgment


Thanks to Dr Mike Weinbren for his useful review of this article.


References 1 Department of Health & Social Care. PM confirms £3.7 billion for 40 hospitals in biggest hospital building programme in a generation. 2020. https://tinyurl.com/y67aky5n


2 Walker P, Campbell D. Most of Boris Johnson’s promised 40 new hospitals will not be totally new. Guardian, 2 October 2020 online. https://tinyurl.com/y4ya4t2m


A plumbed-in drinking water dispenser with the copper supply pipework plumbed directly above an electrical socket.


3 Summary of Incident and Findings of the NHS Greater Glasgow and Clyde: Queen Elizabeth University Hospital/Royal Hospital for Children water contamination incident and recommendations for NHS Scotland. Health Protection Scotland/ National Services Scotland. 20 December 2018.


4 Legionnaires’ disease. The control of legionella bacteria in water systems.


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