WATER SYSTEM HYGIENE & SAFETY
Above: The Markwik 21+ Panel-Mounted Thermostatic Basin Mixer.
Left: An en-suite shower room featuring Armitage Shanks’ Contour 21+ and Markwik 21+ products.
and healthcare staff at the earliest stage. It also requires challenging some of the old guidance, which has now been superseded by newer research. Considering the breadth and complexity of these projects, this example is just one of a vast number of decisions that must be carefully examined from the perspective of water safety. Communicating with and educating stakeholders on this scale, and at the level of detail necessary, was another challenge that emerged during the Water Safety Forum – examples of tasks such as assembling pipework, the positioning of elbow-operated tap levers, and application of sealant to basins, all have serious implications for water safety risk.
It is not possible to have clinical staff
or Water Safety Groups looking over the shoulder of every contractor at all times, and it’s here that targeted education and training can assist contractors in understanding how important their role is, and building the competence needed to identify and mitigate risks. There needs to be a ‘no job too small’ approach to every task, and some basic questions that everyone working on a project should be able to answer, e.g. n Can this task be performed incorrectly? n What are the consequences for patients?
The multidisciplinary approach should extend to manufacturers, who need to proactively add their expertise to help answer these questions. Installation instructions for relevant products must be created from a patient care perspective, according to both where and how they will be used. Again, there is an argument for introducing WSGs at an even earlier stage, ideally before a healthcare- focused product design is signed off for manufacture. If performed correctly, this is
54 Health Estate Journal September 2024
an opportunity for collaboration between manufacturers and WSGs, and allows both to add to their expertise, and ultimately their competence.
A work in progress The vast majority of existing NHS assets aren’t brand new, and patient safety depends on their safe maintenance and operation, as well as engineering best practice being implemented and checked. Establishing competence in a working healthcare environment, rather than building on a static design, is an entirely different proposition, and there are opportunities as well as challenges. Achieving a consistent level of
competence across all the staff working in these facilities has become all the more difficult with job vacancies at record levels, and almost a third of staff coming from service delivery partners. There are anecdotal reports of hospital staff having to give contractors off-the-cuff lessons on best practice when their training hasn’t been adequate. Here, again, the value of the multidisciplinary approach is clear, but so is the difficulty of establishing the same level of competence and urgency across disciplines – what might be second nature to one job role will be challenging and new for another, so feedback has to flow in both directions.
Free on-site training offered The Water Safety Forum was advised that to help combat these potential issues, and develop competencies, Armitage Shanks offers free on-site training to NHS Trusts, highlighting key information and best practice guidance for its Markwik range of thermostatic taps. An advantage of working closely with employees is that it’s possible to hear and respond to their feedback. Existing ways of working can be reviewed and improved faster, and
new solutions tested and implemented, rather than having to wait for long periods before seeing the benefits of new approaches. For example, University Hospital Southampton NHS Foundation Trust has implemented a Water Action Group (WAG) (that reports to its WSG) to examine water sampling results and current hygiene procedures as they happen, and quickly trial and implement improvements. The WAG’s latest focus has been
the ‘one basin, two cloths’ protocol for cleaning basins in the hospital, with one cloth for the basin and another for the taps and drain; cleaning progresses from cleaner areas such as taps to dirtier ones, and finally the water outlet to the drain. The WAG is testing a ‘tweaked’ protocol in which every basin is cleaned with a dry cloth prior to wet cleaning to remove any water residues that dilute the chlorine solution used in the cleaning process. Staff are also being taught how to clean and manage point-of-use filters. Testing the new method on one ward
since January 2023 saw a 53% reduction in positive Pseudomonas aeruginosa samples over a two-week period. This process of trialling and improvement should be a constant in all healthcare settings, and demonstrates the value of a WAG that has the power to change things quickly based on consistent monitoring. One of the key ‘take-aways’ from the Water Safety Forum is that we are all still learning, and we shouldn’t be afraid to share knowledge.
Finding the right people Water Safety Plans should require that potential contractors provide comprehensive evidence of training and competency, and this includes those involved in the commissioning process for new or refurbished facilities. This
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