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WATER SYSTEM SAFETY


Considering the best pipework route for safety


Dave Lancaster, Applications specialist (Building Services) from plumbing, heating, cooling, and infrastructure specialist, Uponor, discusses the risk of Legionella in hospital water systems, and the ways in which that risk can be addressed through design best practice and pipe specification.


Technologies can be combined to ensure the best system to provide hygienic water delivery every time.


In all hospitals, whether NHS or private sector, there are constant challenges around the need to prevent hospital-borne infections from exacerbating existing conditions or prolonging a patient’s hospital stay. The so-called ‘superbugs’ – such as MRSA, CRE, and EBSL – are potential killers, because they are resistant to antibiotics, but, to date, thorough cleaning regimes and vigilance with handwashing have proved effective in reducing and controlling outbreaks. Meanwhile, bacterial infections such as C. difficile can also spread rapidly, but are usually easy to treat with antibiotics, and fatalities are rare. Indeed, Office for National Statistics (ONS) data for both MRSA and C. difficile- related deaths clearly demonstrate that the rate of life-threatening infection has decreased over the past decade, indicating the success of awareness campaigns, cleanliness best practice, and handwashing. Meanwhile, however, the incidence of Legionnaires’ Disease is actually increasing, and the very water systems used to improve handwashing and stem infection in hospitals could be allowing the bacteria to propagate.


How big is the problem?


One of the difficulties with understanding the scale of the problem when it comes to Legionnaires’ Disease is that the condition


Hot and cold services should be kept separate to stop thermal migration.


is difficult to diagnose, and is often overlooked or dismissed as cold or ‘flu symptoms. Consequently, it can be hard to find accurate data, and the recorded incidents may mask a much more endemic problem with plumbing systems that allow and facilitate the growth of Legionella bacteria.


Data from the European Centre for Disease Prevention and Control (ECDC) indicates that the incidence of Legionnaires’ Disease is actually increasing, with the latest figures (for 2015) indicating 412 UK cases, as compared with 370 the previous year, and 331 in 2013. It’s a


concerning trend that is replicated across many European countries, with most showing an increase in cases year on year over the past three years.


Low incidence in some countries The data poses some interesting questions, however. While some countries – including Bulgaria, Romania, Finland, Iceland, and Ireland – report a very low incidence of Legionnaires’ Disease – of <10 cases per year – others, including France, Italy, and Spain, are recording figures of over 1,000 cases per year. Without significant research, it is impossible to know whether these huge discrepancies in the number of cases are due to reporting standards and diagnosis rates, or are more closely aligned to national variations in plumbing design and specification and/or water system management and flushing regimes. Indeed, there may even be correlations between the lifestyle characteristics of different locations, climate or geographic building design, and plumbing specification trends.


Whatever the factors affecting variations in reported cases of Legionnaires’ Disease, the fact that the prevailing trend is for a year-on-year growth in the number of cases suggests that more can be done to reduce the


June 2018 Health Estate Journal 63


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