WATER HYGIENE & SAFETY
decisions. As with all information management systems, the data requires constant updating as people move department etc., and there are various ways via which estates and clinical personnel notify us of staff changes. We issue the contact lists for checking by clinical areas every three months. The escalation contacts are usually senior personnel working in the same area as the primary and secondary contacts. We also, here in Compliance, have access to the report library, and can view flushing compliance data whenever we wish. Digital Missives collates all the data, analyses it, sends out the reminders, monitors the response levels, and issues a variety of useful reports, including weekly ones on the ‘super-escalations’ from the previous week.”
Vince Tennison emphasised that the responsibility for the actual flushing is at ward level. He said: “It’s all about staff understanding ownership of the process, and who has responsibility for water safety when safeguarding patients. ‘Estates’ provides the water up to the point of use, and from there the ward staff look after patient safety, not just for water, but equally in a whole range of other areas. We recognise the daily challenges that the clinical teams face, and thus how we interact with them is vitally important. We cannot come across as judgmental, or indeed dismissive.” At the Trust, low-use outlet flushing is completed by a range of different personnel, depending on the staffing organisation for that area.
Part of the PAM steering Group My interviewee explained that he is part of the national Steering Group for the Premises Assurance Model. He said: “We utilise NHS PAM as a driver for underpinning the foundations of the quality management system, ISO 9001, which we are ultimately working towards. I internally audit my team for water, and we also conduct ward floor walks, 2-3 wards at a time, at each site, every three months, where we talk to the Hospital Support Assistants about flushing and L8guard, and introduce ourselves to the individual in charge of the ward.” At the Trust, water hygiene and safety issues – including low-use outlet flushing compliance – receive clinical oversight from deputy Chief Nurse, Dawn Harper, who also chairs the Water Safety Group. Other WSG attendees include Infection Control and senior Estates and Facilities personnel. Vince Tennison explained: “All the WSG members receive all the automated reports, but I also put the full report bank on the Trust’s SharePoint system. This is in addition to my monthly summary report, in which I analyse and concisely set out the flushing return compliance levels by hospital, ward and
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Many of these are incredibly busy clinical areas, and although flushing compliance can fluctuate, return rates are now typically between 95 and 97 per cent
department, for both Legionella and Pseudomonas. The recipients of my L8guard Monthly Highlight Report are really busy people, and it gives them the key data they need in an easy-to-read format, complete with trend analysis. The concerted approach we take – combining automated emails, my analysis of the various reports, Emma as the human face of L8guard, the meetings of the Water Sub-Safety Group and Water Safety Group, and Dawn Harper’s clinical oversight – gives us a really effective means of monitoring flushing compliance.”
Importance of staff’s contribution Vince Tennison explained that efficient and regular flushing of low-use water outlets supplements the Estates team’s regular chlorination and silver ion dosing. He added: “The Compliance Team also arranges relevant water safety training for key nurses, and the Nursing Directorate’s senior management team. We held the first of a number of planned bespoke onsite courses last December, both for Water Safety Group members and other key personnel, focusing on the management of Legionella. We previously always sent people away for training. The idea is to have a more bespoke training course – in this instance delivered by Deputy Estates & Facilities director, Simon Tighe. He feels the onsite approach gives access to training to a wide range of staff, reducing the travel busy people have to undertake, but, even more importantly, the training is tailored to the Trust specifically. We had an excellent attendance, and a receptive group keen to learn. We are now looking at ways for Simon and I to deliver internal training on Legionella to some of the ward nurses. “Digital Missives,” he continued, “does a fantastic job in managing the data for us; for instance, when we are made aware of staff changes. we simply let the company know and it makes the changes immediately. My latest report showed that in January this year, 2,263 Legionella flushing returns were submitted out of an expected 2,387, showing that there were 124 outlets where no return was received. Although 95% flushing compliance
sounds good, it isn’t good enough, and we must strive for 100%. Realistically, this is a difficult target, but nevertheless one we must strive for.” Another table in Vince Tennison’s latest Monthly Highlight Report that he showed me identified those departments that had demonstrated at least two months of underperforming flushing compliance (below 91%) over a three-month period. Other reports can identify trends over the previous 12 months, so improvements or deteriorations in can be seen for any area.
“Overall, “ he explained, “we have found L8guard to be a key tool in ensuring high levels of low-use outlet flushing; it gives us the peace of mind that one of the key tasks in minimising the risk of Legionella and Psuedomonas in our hospitals’ water systems has been properly and regularly undertaken. We sample for these microorganisms once a month, and, should we suddenly notice a ‘spike’ in viable counts, we can look at the flushing data to see if the location correlates with a particular ward, department, or room where flushing return compliance has been low. Overall, L8guard is an excellent, easy-to-use, and well-designed compliance management system, with functions that can be tailored to user preferences.”
About L8guard
Digital Missives explains that L8guard is ‘a web-based software system that enables users to fully manage low-use water outlet flushing regimes across their entire estate’. It said: “L8guard greatly reduces the administration overheads of processing low-use water outlet risk assessments, while providing up-to-the minute statistical information and analysis.
“By replacing paper-based systems such as log-books, L8guard provides a proactive instant audit trail, helping to ensure ACOP L8, HTM 04-01, and HSG 274 compliance. Low-use water outlets must be identified and flushed through twice weekly, or even daily in critical care areas, and the process must be continually documented to meet HTM 04-01 and HSG274 compliancy. If no low-use outlets are identified, this must also be recorded. In the event of an HSE or CQC investigation, a complete audit trail is necessary to demonstrate compliance. By working with departmental contacts, the system automatically generates risk assessment forms and tracks responses through to completion, escalating when necessary, and providing a fully closed-loop audit trail.”
March 2020 Health Estate Journal 49
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