There is no setting in which water quality is of more importance than one involved with the provision of patient care. Within hospitals, care homes and all manner of medical centres water must be fit for drinking, bathing, cleansing of wounds, cleaning of surgical instruments and general cleaning purposes. In a medical environment the potential for infection is high, and for those already vulnerable – especially with existing respiratory conditions – the consequences of poorly managed water hygiene can be more serious. The Health and Safety Executive’s Health and Safety Guidance 274 Part 2 outlines special considerations which must be made for healthcare centres and care homes and our services to the healthcare sector demonstrate these.

Legionella risk assessment, testing and prevention

The first part of a legionella risk assessment entails carrying out surveys around the clinical site, creating a schematic representation and photographic evidence of water flow. Actions may include testing flow and stagnation, carrying out water tank surveys, testing unused or under-used showers and removing pipework deadlegs. It may also include inspection for aerosol formation and even supplying digital thermometers, recording sheets and basic training to on-site staff. It is essential that the dutyholder is fully aware of their responsibilities and actions to maintain a high quality water system which may include laying down plans for future, scheduled legionella risk assessments.
Special consideration should be given to patients or occupants within healthcare premises. For patients in augmented care units the Health Technical Memorandum HTM 04-01 published by the Department of Health (England) advises that it may be preferable to provide separate small systems with independent supply and local heating sources. Cold water should be maintained at a temperature below 20 °C and hot water stored at 60°C and distributed so that it reaches the outlets at 55°C.
In healthcare, the primary concern is protecting susceptible patients so there are more stringent rules on actions against bacterial sample results in terms of when to investigate, disinfect and retest.

TMV servicing

A thermostatic mixing valve (TMV) is a device that controls water temperature for baths, showers and other outlets by mixing hot and cold water to produce a temperature-controlled flow. Within the healthcare environment these have obvious benefits in preventing scalding to vulnerable individuals, particularly the elderly, people with disabilities and those with sensory loss. For healthcare settings TMV Type 3’s are required, which are designed to be fitted at or as near as practically possible to the point of use, to give extremely sensitive and fast response times to changing system conditions.
However, if not working correctly there is a danger that these units could operate at incorrect temperatures or could allow for the spread of legionella where the system stores stagnant water at a temperature suitable for the bacteria to thrive. Within a medical or care environment we recommend servicing TMVs twice a year which includes stripping down, sterilising and replacing any worn parts before testing and re-commissioning. Where standard shower heads are still in use the process involves dismantling the shower head, descaling and cleaning before disinfecting and flushing in clean water.
Monitoring of hot and cold systems where TMVs are fitted needs careful consideration to ensure the results are interpreted in the context of the conditions where the sample is taken.

Water Safety Groups and Water Safety Plans for top water quality

For healthcare premises, the Department of Health (England) advises the formation of Water Safety Groups (WSGs) to develop the Water Safety Plan (WSP). The formation of a WSG and WSP implementation complements the requirements in the Approved Code of Practice Legionnaires’ disease. The Control of legionella bacteria in water systems.

It is essential to prepare a water management and hygiene programme to ensure regular maintenance of the water system for water quality and future legal compliance. For our services to the healthcare sector, including compliance with Decontamination in Primary Care Dental Practices HTM 01-05, click here.