WATER HYGIENE AND SAFETY


Sound training essential for good design and installation


In this article, Alan Hambidge, a Chartered Biologist, Chartered Safety and Health Practitioner, independent Authorising Engineer, and trainer at Eastwood Park, highlights the need for sound training of those involved in the design and installation of healthcare water services, and the consequences of inadequate training – including water systems where harmful waterborne bacteria can proliferate and put users of the facility at risk.


The safe development, construction, installation, commissioning, and maintenance of hot and cold water supply systems and associated equipment are critical for maintaining good water quality and public health. It has been long known that major refurbishments or other works on water systems can – if poorly managed and designed – result in a significant decrease in water quality, and create situations where pathogenic microorganisms can proliferate. This can occur when conditions are created that reduce water flow, or create stagnation or gross over-capacity, and result in deposition of materials and warm water conditions.


In addition, HTM 04-01 (2016) Part B states that interruptions to water supply can increase the risk of microbial ingress, especially if they result in depressurisation of the supply pipework. The design of systems should ensure that sufficient reserve water storage is available to minimise the consequences of disruption, while simultaneously ensuring that there is an adequate turnover of water to prevent stagnation in storage vessels and distribution systems. It is important to get this balance correct, and to avoid gross over-capacity in the system.


A lack of training


It is now commonplace for estates management staff to be trained as Responsible Persons or Authorised Persons to City and Guilds or similar level, and while it is becoming more common for other members of the Water Safety Group to receive similar training in their specific roles and responsibilities, there remains a lack of training for those involved in the design and installation of water services. This has, on occasion, resulted in poor water systems being designed and installed, which, rather than reducing risk, has actually increased it. In this article, drawing on some 30 years’ experience, I will focus – including via case studies – on the need for sound training of those involved in designing and


installing water services. I will also provide examples of poor designs that have resulted in: n The creation of significant deadlegs. n Short-circuiting and poor water circulation.


n Inappropriate designs. n Poor temperatures. n Gross over-capacity. n Use of inappropriate materials and surfaces.


Root cause analysis


This article has been developed based on the findings of root cause analysis (RCA) reports produced by me for healthcare organisations over the last five years. The reports were produced originally in response to the continued failure of the domestic water systems at the healthcare facilities involved to adequately control the growth of Legionella spp. The aim of such a root cause analysis (RCA) report is to identify and examine the main cause and contributory aspects that resulted in the failure of the water systems, and to propose recommended solutions. As there are many antagonistic and associated factors, it is difficult – in some instances — to be absolute in one’s conclusions, and a combination of short, medium, and long-term actions of both a physical and operational nature will often be needed. However, common themes occur, and it is incredible how


Alan Hambidge develops and delivers Eastwood Park’s current portfolio of water hygiene training courses.


often I find that problems have effectively been engineered into the water systems by poor design.


Background


Legionnaires’ disease is a form of pneumonia, which is caused


HTM 04-01 is a key source of technical guidance on maintaining safe and hygienic water systems in hospitals and other healthcare facilities.


predominately by inhaling airborne water droplets (aerosols) that contain bacteria of the Legionella spp. genus. There is no evidence to show that the disease can be contracted from someone who is already infected. Legionellosis principally affects those who are susceptible due to age, illness, immunosuppression, smoking etc, and can be fatal; hence precautions must be far more stringent in the healthcare environment, as the fatality rate in nosocomial situations can be 30% (approximately 8-12% in the general population). Legionellae can also cause other less serious illnesses which are not fatal or permanently debilitating, but which can affect any person, and their presence is indicative of underlying problems with water quality.


January 2019 Health Estate Journal 59


Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16  |  Page 17  |  Page 18  |  Page 19  |  Page 20  |  Page 21  |  Page 22  |  Page 23  |  Page 24  |  Page 25  |  Page 26  |  Page 27  |  Page 28  |  Page 29  |  Page 30  |  Page 31  |  Page 32  |  Page 33  |  Page 34  |  Page 35  |  Page 36  |  Page 37  |  Page 38  |  Page 39  |  Page 40  |  Page 41  |  Page 42  |  Page 43  |  Page 44  |  Page 45  |  Page 46  |  Page 47  |  Page 48  |  Page 49  |  Page 50  |  Page 51  |  Page 52  |  Page 53  |  Page 54  |  Page 55  |  Page 56  |  Page 57  |  Page 58  |  Page 59  |  Page 60  |  Page 61  |  Page 62  |  Page 63  |  Page 64  |  Page 65  |  Page 66  |  Page 67  |  Page 68