Energy


could be Legionnaire’s disease in a significant percentage of cases.”6 Legionella is naturally present in water


and can rapidly develop to dangerous levels when provided with a source of nutrients from Biofilm within the pipework, or rusted mechanisms within cisterns. For all water system types (except cooling towers), concentration is measured in colony forming units (CFU). Below 1 CFU/mL (1,000 CFU/L) is considered to be at the detection limit, between 1 and 10 CFU/mL (1,000 to 10,000 CFU/L), Legionella amplification could be possible. Contamination results from the inhalation of tiny water droplets that contain the bacteria, with showers presenting an elevated risk due to the steam produced.


Managing the risk of Legionella vs scalding The UK guidance for hot water distribution systems in healthcare is detailed in the Health & Safety guidance HSG274 part 2, which recommends that hot water should


Different areas within the care home require different strategies


be produced and stored at or above 60°C and circulating at 55°C.7


Any temperatures


below this will run the risk of bacteria proliferation, so it is an essential element for patient safety, despite the risk of scalding caused by having such hot water circulating right up to the point of use. This is why thermostatic mixing valves (TMVs) with TMV3 approved technology are required for both safety and legionella control in a healthcare setting.


Advantages & disadvantages of anti-scalding technologies Low and intermediate risk areas Thorough risk assessment is vital in order to find a balance between anti-scalding safety for vulnerable users, and legionella control


and prevention. Different areas within the care home require different strategies – staff areas and visitor areas do not have the same scalding risk. A temperature limiter is the first line of defence for anti-scalding safety, largely adequate for the majority of basin mixer needs. The desired temperature is pre-set within the mixer prior to installation, usually at 38°C. The temperature limiters can also be overridden by maintenance staff, to undertake thermal shocks when necessary. It is suitable for visitor washrooms or staff areas where the scalding risk is low. Staff members would qualify as a low level of risk for scalding as they will generally be habitual users who are familiar with the equipment. Visitors would present an intermediate risk, as although they may not be familiar with the facilities, they have no sensory or mobility issues and are able to use the washbasins safely. However, this technology is unsuitable for vulnerable users – there is no fail safe shut off as it cannot respond in cases of major systemic problems, such as cold-water supply failure. Electronic pressure (EP) balancing options are a good intermediate anti- scalding alternative, suitable for areas with a high frequency of visitors and a moderate level of risk. The integrated ceramic cartridge is sensitive to changes in pressure in the system. An internal shuttle continually adjusts to the incoming hot and cold-water supply pressures to ensure a constant temperature at the outlet, and if there is a failure in the hot or cold-water supply, the water will be reduced to a trickle. This option provides a good degree of anti-scalding safety, while requiring less maintenance than a full TMV3 option.


High risk areas Elderly and vulnerable users in care homes have a greater need for anti-scalding safety measures, as they may have reduced feeling, be medicated, be immune compromised, or have slower reflexes. The risk of scalding for vulnerable people is greatest during whole body immersion, in the shower or bath, meaning that hot water temperatures must not exceed 41°C, and a failsafe is required in the event of hot or cold-water supply interruption. TMV3 thermostatic technology is


recommended by HSG 274 part 2, and is indeed vital in high-risk areas, particularly for showers or baths where there is full bodily immersion. There is a significant scalding risk where patients are immune compromised,


November 2023 www.thecarehomeenvironment.com 35


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