Water, one of the most important substances on earth, is a vital element of patient recovery. Providing access to a safe supply of water is therefore critical in healthcare environments. 

What can go wrong?

Not only is water given to patients to drink but it is also used for clinical purposes, including cleaning surgical instruments and other medical devices. As a result, potentially dangerous water will have multiple points of contact with patients and staff, elevating the risk of infection. 

One water-based health challenge is bacteria. A huge number of different microorganisms, biotoxins and other contaminants – including legionella, the bacteria that causes Legionnaire’s disease – can cultivate in water, presenting a threat to already vulnerable patients. 

Scalding and burns are another risk, particularly for young and elderly patients. 

HTM 04-01 compliance

Clearly, managing these hazards is mission critical in hospitals and other healthcare facilities to avoid serious consequences. Fortunately, Water Safety Groups and the Department of Health (DoH) work together to prevent incidents like these from happening. 

The DoH’s Health Technical Memorandum (HTM) 04-01  provides guidance on legal requirements, design applications, maintenance, safety and operation of hot and cold-water provision in the healthcare sector. 

Hospitals must select products that not only comply with workplace law – such as the Health and Safety at Work Act 1974 and Provision and Use of Work Equipment Regulations 1998 – but also carry out assessments to determine which products present the least risk.

So what support can heating professionals offer hospital management to alleviate some of the pressures currently associated with achieving full compliance?

Specification is the starting point. There can be a tendency to rely on products installed for compliance 10 years ago. But are the existing systems really fit for purpose today? 

Healthcare stakeholders should be encouraged to open their eyes to the innovative, advanced products that have been specifically designed for critical healthcare environments. 

Thanks to improvements in water heating design and technology, these evolved products will outperform existing hospital equipment and offer a more straightforward route to full compliance. 

By highlighting technologies like these, specifiers and contractors can help stakeholders – including estate and facilities mangers, suppliers and NHS management – mitigate the risks associated with hot water provision and identify easily-achievable opportunities for improvement.

Infection prevention

Let’s return to legionella. In terms of design, the challenge is to ensure that liquid is adequately stored, cycled and distributed to prevent a build-up of harmful bacteria, while still minimising the potential for downtime. 

We know that the optimum temperature range for legionella is between 20-45°C. This complicates the compliance process as many plumbing and HVAC units will contain water that sits naturally between these two temperatures.

To combat this, Health and Safety Executive recommends that cold water is kept below 20°C at all times, while hot water should be stored at above 60°C. 

One straightforward means of ensuring gold standard water compliance is to install a point-of-use water heater like Heatrae Sadia’s Multipoint Eco that incorporates anti-legionella functionality. The automatic pasteurisation feature will automatically heat the internally stored hot water to 65°C once, then it will return to its previous mode of operation. This occurs if the stored water remains below 60°C for greater than 21 days in any mode. 

This process eliminates legionella bacteria and guarantees the healthiness of the water, easing the paperwork burden for management while also offering better water provision for both patients and staff.  (Water treatment is also identified as another effective method of bacteria control. For an overview of legionella control, refer to HTM 04-01, part B, 4.) 

Preventing scalding

When it comes to accidental burns or scalding, a practical means of preventing avoidable incidents like these – referred to by the NHS as ‘never events’ – is to select a wall-mounted boiling water dispenser. Some models, like our Supreme series, offer additional safety benefits as any steam generated during heat up is condensed and retained within the unit, preventing scalding or burns.

Avoiding cross-contamination

A further concern in hygiene-critical environments is the need to prevent bacterial build up and cross-contamination. 

Take hot water dispensers, for example. Good water units will incorporate antibacterial silver ion agents, such as Biomaster which prevents the growth of bacteria. This helps keep the surfaces clean and hygienic and reduces the risk of cross-contamination, aiding HTM 04-01 compliance.

In recent tests, Biomaster has also been proven to be active on both porous and non-porous surfaces against SARS-CoV-2, the virus that causes COVID-19 and is a member of the coronavirus family of viruses .

Straightforward maintenance

Maintaining water delivery appliances to a compliant state can also be a pain point for hospital managers – and, by implication, for maintenance and heating engineers. 

Installing products that are designed with simplicity in mind will help avoid prolonged disruption to a hospital’s water supply, which can impact negatively on patients. 

For example, selecting units with built-in inspection hatches and tapless outlets will ensure that upkeep is straightforward, keeping maintenance time to a minimum.

Resilient components

Choosing robust products that are built to last will also help avoid unnecessary time and expense related to maintenance. Polycarbonate tanks, for example, will limit the amount of scale that builds up in a unit, while a conditioner will raise the quality of water supplied in a hospital. This is especially important for the majority of south, east and central England where water is hard to very hard. 

Training and support

Lastly, a thorough understanding of the product and how to optimise operational performance throughout its lifetime is crucial to maintain a compliant state. For this reason, manufacturers like Heatrae Sadia will offer accredited training to installers and facilities management providers, covering all relevant water regulations and bylaws, and compliance for unvented hot water storage systems. 

Informal maintenance overviews for drinking water are also provided for those involved with regular in-house servicing, to help ensure compliance and avoid unnecessary call outs. 

Specifiers and contractors have a key role to play in helping healthcare managers save money, free up time and, most importantly, elevate water safety. With our advanced products and value-added services, we look forward to continuing to support them in this critical work and helping limit the chances of a ‘never event’ from occurring in critical healthcare facilities.