WATER HYGIENE & SAFETY
Don’t takeyoureye offwater safety during the outbreak
With the COVID-19 outbreak, and associated steps to ensure patient, staff, and visitor safety, currently likely to be uppermost in the minds of healthcare estates teams, Dr Susanne Surman-Lee, a State Registered Clinical Scientist, and director of independent public health microbiological consultancy, Leegionella Ltd, warns such personnel against any relaxation of stringent water safety policies and procedures in hospitals and other healthcare facilities.
During the current COVID-19 crisis it is understandable that the routine management of water systems and associated equipment within buildings – including hospitals – may not be highest on the list of priorities for Estates and Facilities teams. However, there is a real risk that without effective water system management, we will be seeing outbreaks of waterborne infections, including Legionnaires’ disease and other waterborne pathogens, unless action is taken now. The European Society for Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Legionella Infections (ESGLI) has produced additional guidance to prevent large outbreaks of waterborne infections, and ensure that patients are correctly diagnosed, by raising awareness and providing practical advice to manage the real risk caused by building water systems during the pandemic.
Many ‘stresses’ on Estates teams The current public health crisis has placed many stresses on Estates teams, including the hurried preparations for COVID-19 patients, reductions in normal healthcare services resulting in buildings being closed, or with a significant reduction in use, and reduced staffing as a result of illness and self-isolation. It is understandable then that routine maintenance, management, and monitoring of water systems and associated equipment have not been highest on the list of priorities. The rapid construction and alteration of facilities for critically ill COVID-19 patients means there has been little
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Figure 1: A hospital ward outlet after not being used for some hours.
time either for the usual consultation, or adherence to best practice guidance, with all the checks and processes normally taken when developing new, or altering existing, water systems. The process of building a new hospital usually takes many years – from design and specification through the build, installation, and commissioning stages, to handover and full operation, so the amazing accomplishment of those managing the Nightingale hospitals and other rapid response projects should not be underestimated.
The rapid construction and alteration of facilities for critically ill COVID-19 patients means there has been little time either for the usual consultation, or adherence to best practice guidance, with all the checks and processes normally taken when developing new, or altering existing, water systems
Low numbers of microorganisms Even when the build and design has followed the normal rate of progression and water delivered to a building meets all regulatory standards, it is not sterile, and contains low numbers of naturally- occurring microorganisms, including Legionella, Pseudomonas aeruginosa, and other waterborne pathogens which, for those of us with competent immune systems ,will normally cause no harm. However, where there has been poor design, specification, and management, of system materials, fittings, and components, and there are conditions within a building which affect the temperature and flow of water – such as overstorage and lack of use – microorganisms can grow within the system so that water delivered at the point of use may not be fit for purpose, and may also pose a risk of serious illness and death to susceptible persons. This includes water systems within buildings which are newly completed.1
The
complexity and size of water systems, and the range of uses of water within the healthcare environment – including water used for patient treatment and diagnosis – increases the number of potential sources and routes of infection. It is therefore vital that appropriate risk assessments and adequate precautions are taken to prevent water system contamination, both during the build, installation, and commissioning of new or altered water systems and associated equipment, and also where buildings have been shut down or have had reduced use. In buildings which have not been used for several weeks, there should have been a flushing programme put in place, or the water systems should have been ‘mothballed’ to be fully re- commissioned when re-opening.
New British standard
The new British Standard 8680:2020,2 just published (the BSI shop link is:
shop.bsigroup.com/BS8680), includes much guidance on the development of
June 2020 Health Estate Journal 51
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