Managing water safety in healthcare environments is critical to maintain patient safety. Water can be a conduit for disease: the vehicle within which bacteria can grow, be distributed around a building, spread to fittings and transmitted to vulnerable patients. Water systems need to be fluid, without dead-legs where water can stagnate; they need adequate temperature controls and the products installed in bathrooms and washrooms in hospitals should be carefully designed to help prevent the spread of infection and reduce other risks, such as scalding, to patients.
Water safety management should start at the very beginning, says Paul Musgrove, Specification Manager for the Health and Care Sector at Reliance Worldwide Corporation (UK) (RWC UK), which supplies the Caremix® range of TMV3 approved taps and showers. “To help effectively safeguard patient welfare once washroom solutions are in use, RWC UK believes water safety management must really begin during and not just after a product’s installation. This is why the robust design features of our Reliance Water Controls® Caremix range are underpinned by a comprehensive technical service,” he says.
RWC UK provides on-site training for anyone installing its products in a healthcare environment, including guidance on how to fit the thermostatic taps and showers to ensure they will meet the required regulations, stand up to the rigorous cleaning regimes and exacting safety standards and to minimise the risk of future issues or damage.
Musgrove continues: “To further aid the installation process, we reduce its complexity by packaging and delivering products such as Showerguard® TMV3 shower valves to be fitted in two clear stages; behind the wall and in front of the wall. Crucially, we also help to easily flush through a system after the first stage fix when all of the components have
been secured behind the wall, to remove any left behind grit and dirt so that the products will confidently meet the demanding requirements of healthcare environments from the moment they have been installed.”
RWC UK believes simplicity is also a key principle to ongoing product maintenance, bringing multiple benefits, particularly in healthcare facilities where inadequate cleaning and disinfection can literally be a matter of life or death.
“Although it’s been a hot topic for many years, poor infection control is still making headlines. Earlier this year an NHS Trust was fined for inadequate Legionella control practices following the death of a patient, who was believed to have contracted Legionnaires’ disease from a hospital shower.
“For this reason, the changing circumstances that surround the issues of Pseudomonas and Legionella control in UK healthcare facilities make the design, supply, installation and maintenance of water systems and products a big challenge. Varying industry viewpoints, interpretations of guidelines and standards, and new technologies also add confusion when it comes to making the right decision on product choice,” says Musgrove.
Simplicity is integral to the design of the Caremix range, which aims to tackle issues of water safety, scalding potential and hygiene and infection control by helping to ensure good clinical maintenance procedures are easily followed to help safeguard patient welfare.
Every tap in the range, as well as Showerguard showers uses a one-piece thermostatic cartridge as standard, thus simplifying maintenance, minimising the risk of mistakes and requiring less stock to be held on site. Products have been designed for ease of cleaning, repair or replacement. A disinfectant flushing hose enables Caremix taps to be cleaned with scalding water in seconds, while the tap is in situ, killing any germs as part of a robust and efficient maintenance programme.
TMVs
Thermostatic Mixing Valves are widespread throughout most healthcare premises. Paul Musgrove believes the thermostatic control of taps is a key requirement to ensure the safe temperature of hot water at the point of use.
TMVs are always required where whole body immersion takes place such as in showers and baths, and where there is a high risk of scalding due to a patient’s mental or physical incapacities. However, some believe TMVs are often over-specified; add to which bacteria grows more quickly on the plastics and synthetic rubbers that can feature in their construction than it would on metal.
Tom Makin, CEO and Chief Consultant of Envirocloud, in his report, Blood, Sweat and Years, Pseudomonas aeruginosa: 6,000 lessons learnt the hard way (reported in Pulse, November/December 2015), says: “In support of the control of opportunistic waterborne pathogens, one of my clients chose not to fit any TMVs at wash hand basins during the construction of a hospital, having first carried out appropriate risk assessments on the likelihood of scalding, in accordance with DoH and HSE guidance. The decision not to fit TMVs was supported by their records showing that in over ten years, there had been just four reported incidents of scalding, only one of which was a patient, and in each case there were no warning signs cautioning users about the presence of hot water. This again
highlights the pervasive issue of over specification of TMVs in healthcare premises, which is not only costly to our inadequately funded healthcare sector but raises the risk of bacterial contamination of outlets.”
Product innovation
Winner of Best Product for Enhancing Infection Prevention at the 2014 Building Better Healthcare Awards, Medi-Shower™ is an anti-microbial shower system comprising shower head, hose, Medi-Flush colour-coded detachable inserts which should be changed quarterly, keys for changing inserts and a quarterly control chart that shows at a glance that cleaning regimes have been followed and the insert replaced. Inserts are returned to the manufacturer for recycling so there is no waste.
Medi-Shower has Biomaster Silver Ion Technology built into the entire product at the point of its manufacture, which cannot be washed or scratched off and remains active for the lifetime of the product. Biomaster has been proven to reduce the growth of harmful pathogens.
Medi-Shower has a smaller internal surface area than a conventional shower head to provide less surface area for bio-film, limescale or bacteria to develop and its MultiShower spray technology is said to provide a more hygiene shower than traditional models.
Water risk management
Speaking at the Healthcare Estates Conference in October, Tom Martin of Environmental Innovations, which specialises in remote monitoring, set out to introduce some ideas about water risk management within healthcare sites. He listed three examples of situations where remote monitoring of the water system around the entire network could help to save money and reduce risks - such as the growth of pathogens and scalding.
Martin noted a trend towards increasing the overall water temperature across a site in an attempt to stop any part of the network falling below a certain temperature. This, he said, was not cost effective and nor was it necessary when remote monitoring would identify potential problems that could be easily resolved – for instance, perhaps extra lagging on pipework would help maintain water temperature. Heating water to a higher temperature also increases the risk of scalding when the water reaches the tap. In America, where the culture of blame is highly developed, legal cases have already been reported after incidents of scalding. Studies revealed that in five out of six American health facilities the water temperature at the tap was sufficient to scald.
The surface temperature of fixtures such as radiators is another potential risk area. Fitting radiators with thermostats to prevent them exceeding the required 43oC, coupled with real-time monitoring of the radiator linked to building occupancy is effective in cost reduction.
Finally, leaks and water mismanagement lead to wasting water and can be very costly, in some cases even leading to ward closures. Remote monitoring of water usage can help to identify potential problems at an early stage, enabling remedial action to be taken and the cost of leaks mitigated.
