WATER SYSTEM HYGIENE AND SAFETY
n Prof. Dr. Martin Exner, of the Institute of Hospital Hygiene and Public Health at University Hospital Bonn.
Following the introductions and welcome, Elise Maynard gave an insightful presentation, focusing on water hygiene risk assessments and best practice in this area. She outlined a very practical approach, and framed her talk around five criteria when examining water delivery in hospitals, which are detailed within BS 8580-1: Water quality. Risk assessments for Legionella control. Code of practice,1 and are applicable to many other waterborne organisms. A standard is currently under development for water hygiene risk assessments (BS 8580-2) around the following areas: n Contamination. n Amplification n Transmission. n Exposure. n Susceptibility.
Poor installation highlighted Elise Maynard covered some key healthcare legislation and bacteria to be aware of, as well as showing images of unsatisfactory installation of water systems, which should be identified during a competent risk assessment. There was a strong emphasis on the importance of how layouts – such as the placing and choice of fixtures and fittings within healthcare environments – can directly affect the spread of bacteria in certain settings. During the talk, there was a discussion around the risks of (multi- drug resistant (MDR) bacteria such as P. aeruginosa, and increasing resistance against commonly used antibiotics. This concluded with the agreement that a focus on prevention is key through the establishment of strong and effective Water Safety Groups.
Dr Elaine Cloutman-Green, from Great Ormond Street Hospital, offered a stark reminder of the importance of infection control, pointing out that a review of hospital waterborne infection outbreaks between 1964 and 2014 showed a year- on-year increase in reports to almost 450 per year, and concluded that current risk assessments are not sufficiently robust in preventing infection. She outlined some key routes of transmission of bacteria, including those from basins and taps, from nurses, visitors, patients in bed, showering, and from hospital equipment. A range of issues were discussed – from the design of en-suite bathrooms, through to contamination of plumbing components during installation, and the disposal of patient fluids and other objects into clinical handwashing basins.
Unseen risks highlighted Dr Cloutman-Green then discussed the potential consequences of unseen risks
130 Health Estate Journal October 2019
advice available through regulation and guidelines on how to reduce the risk of infection. He discussed an incident involving the Liverpool Heart and Chest Hospital, following an investigation by the Health & Safety Executive, where there were two fatalities from Legionnaires’ disease in 2007,2
and another from the
Glasgow Royal Hospital for Children, where bloodstream infections of Cupriavidus paulculus were found between 2016 and 2018.3
Although
Elise Maynard, managing partner, Elise Maynard Associates LLP, and a Council Member of the Water Management Society.
such as bacteria in water droplets from a basin, or those produced as an aerosol from WCs. New research from University College Hospital London Hospitals (UCLH) NHS Foundation Trust has shown that water droplets can travel up to two metres when splashed from a traditional healthcare basin, but new design innovations can significantly reduce this. She also advocated a multidisciplinary approach to water hygiene risk assessments, as there needs to be varying expertise to call on to truly understand both the engineering and clinical risks. She strongly recommended that WSGs be consulted whenever premises are being redesigned or refurbished, with risk assessments completed at key stages for all projects. This, she said, was especially pertinent during the initial design phases. Dr Paul McDermott’s address covered
initially isolated from a washhand basin following the first patient case, widespread contamination (with a variety of waterborne organisms) of the water system was confirmed shortly afterwards.
Need for a multidisciplinary approach
Again, a multidisciplinary approach was deemed essential in healthcare organisations, as any new building designs can be a lengthy and complex process, often taking years. Dr McDermott advised that the design team is key, and that the Water Safety Group should be involved at the pre-qualification questionnaire (PQQ) stage, with a dedicated designer to check quality of work, and ideally also a Clerk of Works. He stressed the appropriateness of utilising existing guidance documents, and their ‘unequivocal ability’ to safeguard lives. However, in many cases, he told delegates, it seems there are times when this advice simply isn’t followed.
The Markwik 21+ collection is a range of thermostatic tap solutions, designed to be disassembled quickly and washed at high temperatures.
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