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 be fully effective alone. It must also be complemented with more holistic and dynamic measures.
HTM04-01 Parts A – C demand that we more closely understand the changing conditions within our water systems and 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 not a recent development, but often their potential is not fully realised. The dynamic nature of what are usually large, complex, and ageing 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.
Here are some thoughts to take away…
- Is BMS information acted upon routinely and effectively?
- Do BMS sensors need calibrating?
- Have the critical alarm settings 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 in the Legionella 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 Legionella risk assessment”
Little-used outlets are both straightforward and fiendishly difficult to manage effectively. This is particularly true on large sites, where departments run outlets depending on the circumstances at differing frequencies, where water safety records management is often inconsistent and there is sometimes a reluctance to remove outlets based on uncertain future use.
A clear and simple 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. Legionella Training does not need to be lengthy to be effective; however, it does need to be restated. Both paper and/or electronic monitoring systems may be used, but both remain dependent upon ownership, at a local 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 to confirm its frequency should also be undertaken, and an approved flushing form must be consistently used. Above all, there must be good communication at all management levels.
Legionella 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 Legionella 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, which should be monitored by the Water Safety Group.
HTM04-01 helpfully recommends a basic agenda of 15 points [not exhaustive] for water hygiene training sessions for those who are involved in ensuring safe wholesome water is delivered 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 RPs, APs, CPs, Infection Control teams, facilities/domestic teams, and other staff remains imperative. At an operational maintenance level, whilst staff Awareness and Competent Persons’ training will broadly highlight current water safety issues, the often-neglected task-specific PPM training for individuals must also be undertaken. Contractors too, must be incorporated into 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 that 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 other Healthcare workers.
Your organisation’s training needs 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 into an outlet.
Conclusion
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 ongoing review is routine and where water safety is given due consideration from the outlet to the boardroom.
Editors Note: The information provided in this blog is correct at date of original publication – November 2017. (Revised January 2025)
© Water Hygiene Centre 2025
