Estates and Facilities teams continue to strive for compliant water systems. Whilst the relatively simplistic tasks we have undertaken for many years, broadly temperature monitoring and condition inspection, remain vital to our knowledge of water safety risks, this approach cannot alone be fully effective and must also be complemented with more holistic and dynamic measures.
HTM04-01 Parts A – C demands that we more closely understand not only the changing conditions within our water systems but also address potential failings of existing complementary control measures from a management perspective. As such, some of the ‘tools’ currently used to minimise risks – whether physical, management or other operational tools can be reviewed further…
Building Management Systems: – Put to best use.
HTM04:01 Part A – Paragraph 11.1 states:- “The continued safe operation of domestic hot and cold water systems requires a number of routine checks to be made by physical means using separate thermometric equipment. A number of the control parameters can, however, be continuously monitored by building management systems (BMS) even though routine checks will still be required for calibration purposes.”
BMS systems are clearly not a recent development, but often their potential is not fully realised. The dynamic nature of what are often large, complex and aging water systems within hospital environments, means we should perhaps consider additional factors e.g. are the BMS sensors fitted in the areas where they are most required? Additional BMS sensors may be useful with the temperature monitoring requirements highlighted in HTM04-01 [Part B Chapter 7, table 1]. Some thoughts to take away – is BMS information acted upon routinely and effectively? Do BMS sensors need calibrating? Have the critical alarm setting been reviewed recently, who receives these alarms?
Little Used Outlets: – A simple workable strategy.
HTM04-01 Part B Chapter 7 table 2 states: – “Consideration should be given to removing infrequently used showers, taps and any associated equipment that uses water… Infrequently used equipment within a water system (i.e. not used for a period equal to or greater than seven days) should be included on the flushing regime. Regularly use the outlets to minimise the risk from microbial growth in the peripheral parts of the water system, sustain and log this procedure once started” The flushing frequency now recommended is “Weekly, or as indicated by the risk assessment”
Little used outlets are, both straightforward and fiendishly difficult to manage effectively, and this is particularly true on large sites, where differing dept.’s run outlets depending on the circumstances, at differing frequencies, where records management is often inconsistent and there is a sometimes a reluctance to remove outlets based on uncertain future use.
A clear and simplistic strategy of control, understood by all, is the only method of ensuring this vital risk minimisation measure remains effective. Issues to consider may include site wide, specific departmental and cleaning / staff training and / or broader awareness via intranet systems. Training does not need to be lengthy to be effective; however it does need to be reiterated. Both paper and / or electronic monitoring systems may be used, but both remain dependent upon ownership, at a flushing and more strategic level. Flushing record audits must also be built into strategies, as the nature of flushing inevitably means its completion may become inconsistent. A formal risk assessment with regard to frequency should also be undertaken and an approved flushing form must be consistently used. Above all there must be good communication at all levels of management.
Training: – A clear strategy.
HTM04-01 Part A Paragraphs 6.29 and 6.30 state: – “Individuals to whom tasks have been allocated (supervisors and managers as well as operatives) need to have received adequate training in respect of water hygiene and microbiological control appropriate to the task they are responsible for conducting…”
“It is important that any person working on water distribution systems or cleaning water outlets should have completed a water hygiene awareness training course so that they can gain an understanding of the need for good hygiene when working with water distribution systems and water outlets, and of how they can prevent contamination of the water supply and/or outlets.”
A robust and comprehensive training matrix in conjunction with competence assessments is also an essential part of any Water Safety Plan [WSP], which should be monitored by the Water Safety Group [WSG].
HTM0-4-01 helpfully recommends a basic agenda in 15 points [not exhaustive] for water hygiene training sessions for those who are involved in the delivery of ensuring safe wholesome water to all outlets and preventing contamination. Much of this agenda can be adopted for the majority of differing roles within your hospital, though tailored training for RP’s, AP’s, CP’s, Infection Control teams, facilities / domestic teams and other staff remains imperative. At operational maintenance level, whilst staff Awareness and Competent Person’s training will highlight broadly current water safety issues, the often neglected task specific PPM training for individuals, must also be undertaken. Contractors too must be incorporated in training plans, to ensure they routinely undertake appropriate training.
Appropriate ‘tools’ for the job
HTM04-01 Parts B & C details to all members of the Water Safety Group the importance of using tools which are appropriate for the task in hand. In particular, to ensure we do not contaminate water systems through poor practices by Competent Persons, Cleaners and Healthcare workers.
The training matrix should ensure these groups of individuals have been identified and include appropriate training schedules, i.e.
- Competent Person and contractors – clean tools and components.
- Cleaners – running outlets and correct use of cleaning cloths.
- Healthcare workers – routine use of outlets and inappropriate disposal of fluids / bodily fluids in to an outlet.
There are clearly many facets that can make water safety management within a healthcare environment operationally difficult, time consuming and often expensive process. As technology improves and once novel systems become more commonly used, the processes we develop to minimise risks from waterborne pathogens become ever more wide ranging. Nevertheless, many of these systems remain only complementary measures and will not replace straightforward and pragmatic approaches to management, undertaken by trained individuals, where on-going review is routine and where water safety is given due consideration from the outlet to the boardroom.