HEALTHCARE WATER SAFETY
Stephanie Lee notes that one of the changes has come in the understanding of bacteria, and particularly Pseudomonas aeruginosa, plus the importance of water controls in fighting infection. She said: “Even as recently as 10 years ago, there wasn’t the understanding of the importance of managing and controlling bacteria, and how water systems can and should play a key part in that. I would say there has been a big step forward in that area, and that knowledge is now more widespread. There’s still room for improvement, but the conversations we have with organisations now about managing Pseudomonas just weren’t happening 10 to 15 years ago.”
Growing knowledge of bacterial control
It’s a trend that Eoin McQuone has recognised, and he agrees with Stephanie Lee about growing knowledge and understanding of bacterial control, particularly in healthcare. His view is that legislation and guidelines will always be a key driver for change. One turning point for him was the introduction of the TMV3 standards into healthcare in 1997. “Over the years at Rada, we have been led on and responded to changes in guidelines,” he explained. “The introduction of the TMV (thermostatic mixing valve) scheme was one area that really created a step change in how people thought, and the way in which they approached controlling water temperatures. It was originally created by the Thermostatic Mixing Valve Manufacturers Association (TMVA), but was then adopted by the NHS. By the time I joined Rada, TMV3 had become the standard for healthcare. At that time, as a manufacturer we went through a big shift to move to thermostatic taps.” The introduction of the TMV3 standard is something that Matt Whiting recalls as being instrumental too. He said: “At the time I was an engineer, and while the adoption of the guidelines didn’t create change overnight, it definitely led to more informed and understanding estates teams when it came to discussing water temperature and control. It was an important step in recognising that water systems in healthcare environments can be complex, and need careful thought and planning, if they’re going to deliver the standards and quality people expect. That in turn has led to ongoing guidelines and improvements targeting higher standards and infection control in healthcare water systems.”
Changes in Legionella guidance All agree that changes in Legionella guidance have been instrumental too. Eoin McQuone points to the Health and Safety Executive’s guidelines on Legionella (‘L8’) as particularly important. These specifically linked temperature and
60 Health Estate Journal February 2019
infection control, and introduced more comprehensive measures to stop the proliferation of bacteria in water systems.
Best practice guidelines
A further influence on the management of water in healthcare has been the introduction of the the Health Technical Memoranda (‘HTMs’). First introduced 30 years ago, the series provides best practice engineering standards and policy to enable healthcare facility providers to meet their duty of care to patients and residents. Healthcare-specific technical engineering guidance has become a vital tool in the safe and efficient operation of healthcare facilities, and the main source of specific healthcare-related guidance for estates and facilities professionals. It is HTM 04, which focuses specifically on water controls, that has understandably been of most interest for the team at Rada. “Alongside the HSE guidelines, HTM 04 tightened up the risk assessment procedure and helped people become more aware of some of the challenges of waterborne pathogens,” Eoin McQuone said. “We were already developing and leading on digital products at this time, but the HTM’s publication helped create further focus on the value that digital products could bring.
A ‘step-up in performance’ “They offer a step-up in performance compared with mechanical products. The biggest performance change is being able to automate duty flushing. Previously, this was a manual process, which always has the potential to be open to human error,” he added. Eoin McQuone explained how the focus on compliance and accurate record-keeping brought about by new guidelines had ‘underlined the value of digital’. He said: “Rada’s Digital products allow users to comply more easily with the duty flushing requirements, by setting times when they want duty flushing to be undertaken. The products offer highly
flexible programming options, to ensure that duty flushing will happen when it is programmed to, rather than relying on staff to undertake that function. Rada’s digital products also have a ‘smart duty flush’ function which will stop the valve from flushing unnecessarily. If the device has been used within a given time period, it won’t need to perform its duty flush, saving water and energy resources, while still ensuring compliance. It also helps to avoid human error.” Rada says the digital products also provide more accurate control of temperature, to ensure that thermal disinfection is carried out at the appropriate temperature, while of further value is the fact that the digital products keep a record of this, and can produce a report showing how and when functions have been carried out.
“A machine cannot make a mistake in the same way a human can,” said Eoin McQuone. “With digital products, the estates team can have absolute confidence that duty flushing measures have been undertaken, in the manner and at the frequency they should be, and that the user has the data log to prove that.”
Positive feedback
The performance of Rada’s digital offering has seen demand for its products grow. Rada Acu, the company’s digital tap for baths and basins, and Rada Sense, its digital shower, were originally developed specifically for healthcare, and feedback has been positive. As well as the benefits of digital performance, Rada Acu is non- touch, offering a further key advantage for healthcare, by reducing the risks of cross-contamination between hands and products.
Matt Whiting also feels that additional measures and recommendations added to the HTM 04 01 guidance in March 2013
Pseudomonas aeruginosa. Stephanie Lee says one of the changes of recent years has been better understanding of waterborne bacteria.
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