WATER HYGIENE AND SAFETY – SPECIAL REPORT
The challenge of keeping water clean and safe
Maintaining the water supply in healthcare facilities in a safe and hygienic condition is among the more taxing tasks that healthcare engineering professionals face. Indeed, as former PHE scientific leader in Water Microbiology and Decontamination, Dr Jimmy Walker, and consultant medical microbiologist, Dr Mike Weinbren, point out in an article in the following pages, ‘The water cycle of a healthcare building is an immensely complicated system, requiring good design, correct selection of components, a hygienic building, monitoring, maintenance, and management’. HEJ’s editor, Jonathan Baillie, sets the scene for some of the key topics covered in this 'digital only' water hygiene and safety in healthcare special report.
In their comprehensive article focusing on the fundamentals for maintaining healthcare water systems in safe and hygienic condition, Drs Jimmy Walker and Mike Weinbren not only explain what legislation and official guidance require, but also highlight some of the biggest challenges that healthcare engineers face in maintaining the water supply in a clean, safe, and hygienic condition. Many of the issues covered will be familiar to those responsible for healthcare water systems, but, particularly in large hospitals with extremely extensive pipework, and where a number of clinical and non-clinical spaces may be only in intermittent use, keeping the water circulating to prevent stagnation, biofilm build-up, and a conducive environment for bacterial growth, can be a significant logistical challenge, as well as a pretty resource- intensive task.
While thorough cleaning of outlets, good practice in washbasin use – particularly in clinical areas housing immunocompromised patients – and regular flushing, are key, engineering solutions also play a significant part in ‘the battle against the bugs’. For instance, ensuring that hot water pipes are properly insulated to prevent heat loss, especially where they are located close to the cold water supply, the use of hot water circulation pumps to regulate the balance of individual pipe branches and different loops, and paying particular attention to the periphery of the water system – ‘the last two metres’ – are all critical elements. Equally, regular sampling, and having in place an effective, quickly implementable strategy should, for example, high counts of Legionella or Pseudmonas aeruginosa be found, are all part of a good Water Safety Plan.
In recent years, prompted by revisions to HTM 04-01, official guidance has emphasised the value of Water Safety Groups and Water Safety Plans – and
with so much of good practice in healthcare, effective and regular communication between all disciplines is a key tenet of good water hygiene and safety.
indeed HEJ has regularly reported on their positive impact, particularly in large hospitals, where good stewardship of often very extensive water systems requires a multidisciplinary, ‘teamwork’ approach. A good Water Safety Group and associated Plan will, for example, not only rapidly identify any areas prone to high bacterial counts, and ensure that, if necessary, monitoring is stepped up, but will also bring together healthcare engineers, Infection Prevention and Control specialists, and FM personnel, to ensure a concerted approach. While effective policies need to be agreed at a management/strategic level, without good frontline staff training – for example to ensure that cleaners not only employ best practice, but also understand the science behind it – even the best water safety strategy will fail. Indeed, as
The COVID crisis has shone an even greater spotlight on hospital hygiene and infection control, and the ramifications of this global pandemic are likely to be with us for some time to come. As Jimmy Walker and Mike Weinbren point out, ‘the bacterial journey started in the oceans of our planet billions of years ago, and this water is the bacteria’s primary kingdom’. Given this, water safety and hygiene will always be a major concern for healthcare engineering teams, and indeed how best to combat and, wherever possible, eliminate, hazardous levels of waterborne bacteria will continue to be debated among scientists, sanitaryware suppliers, clinicians, and the healthcare engineering community for years to come, as science offers new solutions, and technology adapts accordingly. Some fundamentals to maintaining a safe and hygienic water supply, however remain constant. The articles in this special report reflect this, and highlight what, in the experience of the authors, and based on scientific evidence, are some of the most effective means to keep the water used by patients, visitors, and staff, clean and safe. Interestingly, in her article, clinical scientist, Dr Susanne Surman-Lee, argues that many of the problems surrounding poor quality of water in healthcare are ‘due to a lack of ownership, lack of detail in contracts, and poor understanding and training of those involved in the design, specification, build, installation, and commissioning’.
Thanks to all the authors for their expertise and input, and for taking the trouble to put pen to paper so expertly. I am sure that readers will find the content of this special report an interesting and worthwhile read.
hej December 2020 Health Estate Journal 7
©Peter Bocklandt
BOK1@Telenet.be
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