WATER SYSTEMS
healthcare setting vulnerable patients are much more susceptible to serious scalding injuries because of many factors, such as thinner skin and delayed reaction time. ‘Risk of scalding’ is still on the NHS ‘Never Events’ list,9
which
was last updated in February 2021 thus highlighting its continued relevance. The list is for all
organisations that provide NHS care of serious incidents that are preventable through guidance or safety recommendations, which should be implemented by all healthcare providers on a national level. WSGs should follow this guidance through the fitting of TMVs.
the necessary precautions to ensure that the safety of their end-user is consistently maintained when thermal disinfection takes place. For example, they should aim to temporarily close specific areas of wards in order to allow thermal purging to occur. If this is completed with a TMV equipped with a thermal override function, the process should be quick and simple to perform – keeping down-time to a minimum. Ultimately each healthcare
TMV allow a thermal flush to take place right to the outlet.
Thermal disinfection must be done throughout the entire system Although most TMVs installed within a healthcare setting, as long as they adhere to the previously discussed standards, disinfect 95 per cent of the water system, there are still places where Pseudomonas can potentially form and grow. A common area is a dead-leg where either pipework has been altered and no longer in use, where the water may sit stagnant or where there is infrequent use of the water being drawn off. Every effort should be made to eliminate or reduce these areas, including keeping pipe runs from a TMV to the terminal fitting as short as possible to reduce risks or bacterial growth. The UK Health and Safety Executive’s
approved code of practice and guidance on regulations on controlling Legionella bacteria in water systems states that operators should consider the individual nature of the site and system as a whole, including deadlegs and parts of the system used intermittently.10
These, it
continues, should be included because they can create particular problems, as microbial growth can go unnoticed. When they are brought back online, they can cause heavy contamination, which could disrupt the efficacy of the water treatment regime.
A full thermal flush of a water system -
right up to the outlet – is advised to remove the Pseudomonas present in the terminal fitting. To do this, each valve will need to be bypassed in order to successfully complete the thermal disinfection. However, this task can be heavy reliant on resource and time meaning it is costly for trusts especially in a facility with multiple outlets and TMVs. Instead, WSGs and HFMs should aim to
source TMVs that allow a thermal flush to take place right to the outlet. The Mixcal Careflo Plus TMV has been designed to meet the requirements of BS 7942:2000
IFHE DIGEST 2022
and the NHS model engineering specification D08 for use in healthcare settings, hospitals, care homes and schools. This model allows a facilities manager to use a special tool and the manual override function, which ensures thermal disinfection is performed through to the outlets, enabling a complete rather than a partial flush.
Conclusion
Both thermal and chemical disinfection methods have their drawbacks, safety-wise and hygienically. Due to this, WSGs and HFMs should take their time in selecting which method they feel to be most appropriate for each individual system. The UK Department of Health and Social Care suggest in HTM04-01 Part A, there is no single water treatment regimen that is effective and appropriate in every case, and each system has both merits and limitations.11
Taking this suggestion
into account, the most ideal WSP for any healthcare setting would include a combination of thermal and chemical disinfection, as well as other physical water controls. Furthermore, by combining multiple methods of water control and disinfection the pseudomonas present in the system may struggle to mutate to survive these methods. Being in a healthcare setting, mutated Pseudomonas could cause catastrophic issues with the vulnerable end users. However, this has a large cost in time and resources, one that many NHS facilities cannot afford. Due to this, the conclusion that can be made is that while both methods of control have their drawbacks it is apparent that thermal disinfection offers the best solution. Thermal disinfection ensures the safe supply of drinking water while also providing control over pseudomonas. This method provides the most hygienic disinfection, with limited risks of reversing this disinfection, to the water system. However, HFMs and WSGs should take
facility, and their HFM and WSG, must make their own decision and must complete a risk assessment that is specific to
their facility. They may use the advice given to them however, there are many factors that play a major role in finalising a stringent WSP, which limits risk to safety and hygiene as much as possible.
References 1. Department of Health and Social Care, Health Building Notes,
https://www.gov.uk/ government/collections/health-building- notes-core-elements, June 2017.
2. Department of Health and Social Care, Safe Water in Healthcare Premises (Health Technical Memoranda 04-01) – Safe water in healthcare premises (HTM 04-01), April 2017.
3. Department of Health and Social Care, Health and Social Care Act 2008: Code of Practice on the Prevention and Control of Infections, July 2015.
4 Department of Health and Social Care, pg. 16, 4.5, Health Technical Memorandum 04-01: Safe Water in Healthcare Premises – Part B: Operational Management, April 2017.
5 Department of Health and Social Care, pg 38, 7.6, Health Technical Memorandum 04-01: Safe Water in Healthcare Premises – Part B: Operational Management, April 2017.
6. Department of Health and Social Care, pg. 24, 4.8, Health Technical Memorandum 04-01: Safe Water in Healthcare Premises- Part A: Design, Installation and Commissioning, April 2017.
7 Department of Health and Social Care, pg 16, 4.9, Health Technical Memorandum 04-01: Safe Water in Healthcare Premises - Part B: Operational Management, April 2017.
8 Department of Health, Health Building Note 00-10 Part C: Sanitary Assemblies, 2013.
9. NHS Improvement, Never Events list 2018, Jan 2018 (updated February 2021).
10. Health and Safety Executive, pg. 12, 39, Legionnaires’ Disease: The Control of Legionella Bacteria in Water Systems- Approved Code of Practice and Guidance on Regulations, 2013.
11 Department of Health and Social Care, pg. 24, 4.11, Health Technical Memorandum 04-01: Safe Water in Healthcare Premises - Part A: Design, Installation and Commissioning, April 2017.
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