News archive - November 2016
Blowing germs out of the water
As water deregulation approaches in 2017, many healthcare organisations are taking a closer look at their water management systems and finding that, while compliant, they are inefficient and out of line with their ambitions to drive down operational costs and improve sustainable performance.
One area of focus is infection prevention and control, following a number of high-profile outbreaks of potentially-deadly Pseudomonas aeruginosa and Legionella in hospitals and care homes across the UK.
From a regulatory standpoint, the updated Health Technical Memorandum 04-01: Safe Water in Healthcare Premises gives advice and guidance to organisations providing patient care.
Since May this year, advice on the control of Pseudomonas has been incorporated into the main body of the document, as Part C. The HSE has also taken a pro-active stance and consulted widely with industry when drafting its latest HSG 274 Part 2 guidelines for the control of Legionella in hot and cold water systems.
This has, in turn, led manufacturers to design new systems aimed at helping to keep water systems free from bacteria, and to support estates and facilities managers with monitoring and auditing tasks.
Speaking to hdm, Paul Harper, divisional director at Minimise Water, said: “Recently there has been a focus on improved training - ensuring that those responsible understand the legislation and are able to take the correct action.
“Online training has made this easier. There has also been an increased emphasis on learning through networking and trade events and qualified consultants are now being employed as independent bodies to assist or write policy documents.”
Among a number of systems, the company has recently launched its Compliance Online solution to provide continuous, granular water temperature monitoring. This will improve Legionella compliance, immediately highlighting problems and providing all-important data on how to manage the systems. Currently this is often done manually - proving inefficient and expensive.
IDEXX Water has also launched its Pseudalert test for the rapid monitoring and detection of Pseudomonas contamination in hospital water systems. This followed a peer-reviewed, pan-European comparative study of the test against current methods, demonstrating its greater sensitivity and speed.
When considering changes to current water monitoring and treatment methods, Harper says a complete understanding of the risks is vital.
He told hdm: “Careful consideration needs to be given to the responsibly-appointed person. Do they understand the legislation, the system and requirements, and are they suitably trained and empowered to make decisions, both in terms of ownership and budget? Also, are sub-contractors industry recognised, affiliated to recognised trade bodies and associations, and is their work vetted? These are all vitally important.”
Choose your strategy
Richard Sinden, life sciences product innovation and regulation director at SUEZ Water Conditioning Services, adds: “Facilities managers need to recognise there is no panacea solution to the control of water-borne infection risks.
“Organisms differ in the way they infect water systems, the conditions in which they thrive, and strategies required for their control.
“While Legionella almost always enters a hospital water system from the external supply, for example, Pseudomonas can enter on the skin of patients and staff and get into pipework through taps or shower fittings. It can also grow in water temperatures as low as 5°C, which means that, unlike Legionella, it can’t be managed by tight control of supply temperatures. Even the monitoring protocols differ for different micro-organisms.”
And Nigel Otter, marketing manager at IDEXX Water, said: “Testing needs to be rapid and definitive, and, secondly, monitoring needs to be undertaken on a regular basis as part of a water safety plan.
“Frequent, non-compliance testing can be done easily and effectively in-house without the need for highly-skilled laboratory technicians.”
There are a range of systems now available, and choosing which works for a particular area is often difficult.
Harper said: “There are a range of chemical engineering options, but the most-recent advances are the technologies that assist in the real-time continuous water temperature monitoring, management and reporting of systems.
“Because monitoring is continuous, the risk of exceptions being missed is significantly reduced. This ensures that problems are spotted at the earliest opportunity rather than waiting for a manual, monthly check. It also regulates reporting.”
Sinden adds: “As our understanding of the behaviour of water-borne infections has improved, there have been lots of advances in water systems technology, from the development of advanced biocides to improvements in the design of outlets and fittings to reduce the risk of colonisation by bacteria.”
But, he warns: “Technological changes are no substitute for a rigorous approach to the design, operation, and management of water systems.
“Many of the most-important measures are simple in principle, but deceptively challenging in practice, like eliminating deadlegs in piping or under-used water fittings, or training staff in the safe use of handwashing facilities.”
Preparing for the future
As industry prepares for the future, an important focus for both healthcare operators and manufacturers will be helping to collect the all-important data on which decisions on water safety will be made.
Harper said: “Along with other infrastructure sectors, we’re developing new ways to collect and use data efficiently.
“The next few years will be really important, with systems becoming more sophisticated and offering increased functionality.
“More pro-active organisations will be able to deliver better reporting systems, technologies, and information management.
“The impact of water deregulation will also be a catalyst for change, as will the continued investment in foreign chemical research.
“I expect there to be increased demand for, and competency in, the delivery of the exact dose of biocides matched to the application.”
Sinden adds: “The battle against water-borne infections requires an intensely-collaborative approach. Every facility should establish a water safety group and put a plan in place. They should ensure they understand the risks presented by different types of infection, and the different strategies required to control them, and they should engage with water companies, service companie,s and facilities management groups and work together to develop and implement best practices.
“Ultimately, the control of microbial risks requires a combination of system design, management, compliance, monitoring and training - in combination with the best available technology.”