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Safe Water in Healthcare
A Practical and Clinical Guide
- 1st Edition - March 20, 2023
- Authors: James T. Walker, Susanne Surman-Lee, Paul J. McDermott, Michael Weinbren
- Language: English
- Paperback ISBN:9 7 8 - 0 - 3 2 3 - 9 0 4 9 2 - 6
- eBook ISBN:9 7 8 - 0 - 3 2 3 - 9 0 4 9 3 - 3
Safe Water in Healthcare: A Practical and Clinical Guide enables users from different disciplines to understand all types of waterborne hazards that can pose a risk to those who… Read more
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Request a sales quoteSafe Water in Healthcare: A Practical and Clinical Guide enables users from different disciplines to understand all types of waterborne hazards that can pose a risk to those who might be exposed, the events which cause them to be present, what may precipitate an increase in their levels that may cause harm, and how they can be avoided or managed to reduce risk. The handbook highlights microorganisms that can cause infections, modes of transmission, the infections they cause, and risks. The book's authors draw from their extensive practical experience assisting with day-to-day problems that range from minor issues to outbreaks.
The book includes case studies on the growth of biofilms and where they cause problems in water systems as well as providing practical answers to a majority of issues that arise in healthcare water and drainage systems. This is an accessible handbook that fills the gaps for those without technical knowledge for a complex but important area of infection control. It provides practical guidance for professionals who are required to design, manage and maintain water systems and help them manage associated infection outbreaks.
- Discusses waterborne pathogens, their detection, identification and surveillance and describes the extent and range of recognized and emerging waterborne microorganisms as well as the diseases that occur and consequences to patients and staff
- Covers hazards that can cause harm within water systems and associated equipment, the circumstances or factors that increase the risks, and the multiple modes of transmission of waterborne pathogens
- Explains the importance of good design, including the type of design, management, hardware and software that can help manage and control the presence of waterborne pathogens.
- Highlights who needs to be involved at each stage to ensure that patients are kept safe from waterborne pathogens, taking into account current legislation and best practices guidance
Public health practitioners, public health engineers, healthcare providers, infection prevention specialists, directors of infection prevention and control, nurses, clinicians, microbiologists, water safety groups, facilities managers, researchers, academics, engineers, planners, microbial diagnostics companies, water treatment companies, architects, quality systems specialists
- Cover image
- Title page
- Table of Contents
- Copyright
- Dedication
- Preface
- Acknowledgment
- 1: Importance of leadership and governance
- Abstract
- Overview
- Leadership
- Governance
- In summary
- References
- 2: Design, construction, and commissioning of healthcare water systems
- Abstract
- Introduction to designing safe water systems
- Project water safety plan
- Project governance and accountability
- Handover
- References
- 3: Overview and introduction to safe water in healthcare
- Abstract
- Background
- Introduction to biofilms
- Case study: Microbial contamination of flexible hoses
- What areas of the water system present microbial risks?
- Learning points
- References
- 4: Cold water systems
- Abstract
- Introduction
- The cold water supply
- Microbial hazards in the supply water
- Water quality within the building
- Why do you need cold water storage?
- Design and construction of cold water storage vessels
- How much cold water should be stored?
- Temperature management of the cold water
- Microbiological risks associated with cold water tanks
- Monitoring of the cold water system
- Maintaining cold water supply in an emergency
- Recommendations for cold water systems
- Learning points
- Risk assessing the cold water system
- Guidance, regulations, and further reading relevant for cold water systems
- References
- 5: Hot water heating systems
- Abstract
- Hot water system
- Temperature requirements for hot water calorifier, flow, and returns?
- How is hot water produced?
- What is stratification?
- Electrical immersion-type calorifiers
- Combination water heaters
- Microbiological problems with calorifiers and hot water systems?
- Transmission routes for calorifiers and hot water systems?
- Monitoring hot water systems
- Recommendation for hot water heaters
- Regulations and guidance for hot water heaters
- Risk assessing the hot water system
- References
- 6: Systemic contamination
- Abstract
- Identifying systemic contamination?
- How does systemic contamination occur?
- What are the impacts of systemic contamination?
- Monitoring systemic contamination
- Recommendation for systemic contamination
- Issues to consider when risk assessing systemic contamination?
- Guidance for systemic contamination
- References
- 7: Peripheral components
- Abstract
- Introduction
- Why are peripheral components colonized?
- Strainers to trap harmful debris
- Thermostatic mixer valves
- Solenoids
- Flexible hoses
- What other types of peripheral components are used?
- Different type of outlets fittings
- Recommendations for peripheral components
- Risk assessment considerations for peripheral components
- Regulations for outlet fittings
- References
- 8: Wash hand stations
- Abstract
- How do wash hand stations become contaminated?
- What are the transmission routes and microbial risks?
- Activity space
- Splashing and dispersal from wash hand basins
- What does a safer wash hand station look like?
- Patient wash hand station
- Recommendation for wash hand stations
- Assessing the risks associated with wash hand basins
- Regulations for wash hand stations
- References
- 9: Sinks in ward kitchens or domestic areas
- Abstract
- What is a sink and what is it used for?
- What are the microbial contamination sources of stainless steel sinks?
- What are the transmission routes?
- Outbreaks associated with stainless steel utility sinks
- Guidance on sinks
- Recommendation on sinks
- Risk assessments for sinks
- Questions on sinks
- References
- 10: Showers
- Abstract
- Showers and accessories
- What are the microbiological risks with showers, hoses, and showerheads?
- Shower controller unit
- Shower hoses
- Shower heads
- Ancillary equipment in showers
- Deluge showers
- Shower trolleys
- Patient risk and risk to patients
- Microbial outbreaks associated with showers rooms
- Microbiological monitoring
- Requirements and recommendations for showers
- Risk assessing showers and their equipment
- Guidance
- References
- 11: Assisted baths
- Abstract
- Assisted baths for patient care
- Microbiological problems associated with assisted baths
- Bath accessories and bath toys
- Monitoring of assisted baths
- Recommendations for assisted baths
- Risk assessing assisted baths
- Guidance for assisted baths
- References
- 12: Birthing pools
- Abstract
- Birthing pools
- What are microbiological risks from using birthing pools?
- How do birthing pools become contaminated?
- Risk assessment criteria for birthing pools
- Guidance and regulations relevant for birthing pools
- References
- 13: Hydrotherapy pools
- Abstract
- What are hydrotherapy/aquatic physiotherapy pools?
- What is aquatic physiotherapy?
- Design
- Commissioning
- Governance
- Bather loads
- How does a hydrotherapy pool function?
- Backwashing
- Day-to-day management
- An overview of the hazards applicable to hydrotherapy pools
- Patient screening
- Fecal pathogens
- Nonfecal pathogens
- Main challenges for hydrotherapy pools
- Emergency action plans
- Outbreak 1
- Hydrotherapy tanks/tubs/pools used for burns, etc.
- Whirlpool baths and assisted baths
- Spas, hot tubs, footbaths, etc.
- Microbiological monitoring of hydrotherapy pools
- Criteria for risk assessing birthing pools
- Guidance and regulations relevant for birthing pools
- Terminology
- References
- 14: Sources of patient drinking water
- Abstract
- Sources of drinking water
- Chilled drinking water dispensers
- Outbreak scenarios
- Monitoring of drinking water sources
- Guidance for chilled drinking water fountains
- Requirements and recommendations for chilled drinking water fountains
- Bottled drinking water dispensers
- Recommendations for bottled water dispensers
- Risk assessing water coolers and other drinking sources for patients
- Guidelines for bottled water dispensers
- References
- 15: Drink vending machines
- Abstract
- Drink vending machines
- Microbiological issues associated with drink vending machines
- Monitoring of vending machines
- Recommendations for vending machines
- Risk assessing vending machines
- Regulations for vending machines
- References
- 16: Expansion vessels
- Abstract
- What are expansion vessels?
- Microbiological sources and problems associated with expansion vessels?
- Microbial contamination of expansion vessels and seeding the system?
- Microbiological monitoring of expansion vessels
- Regulations relevant to expansion vessels
- Recommendations for expansion vessels
- Risk assessing expansion vessels
- References
- 17: Ice making machines
- Abstract
- Background
- Ice production in healthcare
- Why is ice used for patients?
- Design and components of ice machines
- What are the sources of microbial contamination?
- What are the microbial transmission routes?
- What are the microbiological risks with ice machines?
- Microbiological monitoring
- Microbial targets and action alerts for ice machines (Table 1) (PHE, 2020)
- Risk assessing the requirement for ice
- Recommended practice for ice machines
- Example of a cleaning and maintenance regimen
- Risk assessment criteria for ice machines
- Guidelines for ice machines
- References
- 18: Dirty utility rooms
- Abstract
- What is a dirty utility room?
- Location
- Design
- Size
- Impact of design on splash contamination
- Are hoppers and separate cleaning sinks necessary?
- Layout of the dirty utility room
- Drainage
- Storage
- Outbreaks and incidents associated with dirty utility rooms and hoppers
- What monitoring should be considered?
- Governance
- Recommendations for dirty utility rooms and facilities
- Considerations for risk assessing your dirty utility rooms
- Guidance and further reading for dirty utility rooms
- References
- 19: Laundry rooms
- Abstract
- Background
- Microbiological issues related to laundry
- Other issues related to laundry and water
- Case study—Multisite B. cereus outbreak related to laundry management
- Case study—Low volumes of rinse water to improve water efficiency
- Case study—Impact of unsatisfactory bacterial levels in incoming water supply
- Requirements for consideration in laundry of linen
- Risk assessing microbial contamination in hospital laundry units
- Guidance relevant to laundry of linen
- References
- 20: Endoscope washer disinfectors
- Abstract
- Introduction
- What are endoscopes and how are they cleaned and disinfected?
- What are the sources of contamination of endoscopes?
- What are the transmission routes with endoscopes?
- Outbreaks and incidents associated with endoscopes and endoscope washer disinfectors
- Monitoring water associated with the decontamination suite
- Recommendations for rinse waters
- Considerations for risk assessing endoscope washer disinfectors and rinse waters
- Regulations and guidance relevant to rinse waters and EWDs
- References
- 21: Cardiac heater coolers
- Abstract
- Acknowledgment
- Introduction to cardiac heater coolers
- Microbial contamination of cardiac heater coolers
- What monitoring should be carried out for cardiac heater coolers?
- Risk assessing heater coolers
- Recommendations for heater coolers
- Guidelines for heater coolers
- References
- 22: Dental chairs and dental unit water lines
- Abstract
- Acknowledgment
- Dental chairs and dental unit water lines
- What are the microbial contamination sources of dental chairs and associated equipment?
- What are the transmission sources?
- Monitoring dental chair water systems
- Requirements for dental practices and dental chairs
- Recommended practice for dental practices and dental chairs
- Guidelines for dental chairs, dental unit water lines, and spittoons
- References
- 23: Drains and wastewater
- Abstract
- Introduction
- Drain-associated transmission of infections
- How are drains contaminated?
- Reducing clinical hand wash station risks from drains
- Summary
- References
- 24: Reverse osmosis systems
- Abstract
- Acknowledgment
- What are reverse osmosis units and what are they used for?
- Design and operation of RO units
- What is renal dialysis water?
- What are the sources of microbial contamination?
- What are the routes of dispersal of microorganisms from RO units?
- What are the microbiological risks with RO units?
- Microbiological monitoring for RO units
- Guidance for reverse osmosis units
- Requirements and recommendations for RO units
- References
- 25: Remote monitoring of water temperature and biofilms
- Abstract
- Acknowledgment
- Why you should monitor your water system
- Novel approaches to hot and cold water temperatures
- Advantages of remote monitoring
- Monitoring water temperatures at outlets
- Monitoring the performance of other parts of the hot and cold water system
- Additional benefits of remote monitoring
- Carbon footprint and the economics of water resources
- Impact of remote monitoring on reducing the risk to patients
- Linking remote monitoring to automated flushing events
- On-site biofilm detection methods
- Conclusions
- References
- 26: Waterborne pathogens in healthcare water systems
- Abstract
- Introduction
- Opportunistic pathogens
- Advances in the identification of microorganisms
- Legionella
- Pseudomonas aeruginosa
- Stenotrophomonas maltophilia
- Cupriavidus pauculus
- Nontuberculous mycobacteria
- Protozoa and amoeba
- Fungi
- Biofilm
- References
- 27: Clinical surveillance of waterborne infections
- Abstract
- Acknowledgment
- Introduction
- Clinical surveillance
- Environmental surveillance
- Water sampling
- Routine/ad hoc environmental sampling
- Sampling and swabbing of water system components
- Actions associated with surveillance of healthcare water-associated infections
- Guidance for surveillance
- References
- 28: Role of the water safety group and water safety plans
- Abstract
- Introduction
- Sources of opportunistic pathogens in healthcare buildings
- What are water safety plans and why are they important?
- What are the benefits of the water safety plan approach?
- Why do you need a water safety group?
- Understanding modes of infection
- Training and education
- Conclusions
- References
- 29: Controlling the microbial quality of water systems
- Abstract
- Introduction
- Control strategies
- References
- Index
- No. of pages: 446
- Language: English
- Edition: 1
- Published: March 20, 2023
- Imprint: Academic Press
- Paperback ISBN: 9780323904926
- eBook ISBN: 9780323904933
JW
James T. Walker
Dr Jimmy Walker worked as a Scientific Leader in water microbiology and decontamination at Public Health England (PHE), Porton UK. He has 30 years’ experience in public health microbiology with an extensive publication record, and regularly attended national and international scientific conferences. His particular interests were the presence of opportunistic pathogens in hospital water systems and advised hospitals on incidents and outbreaks associated with waterborne pathogens such as Legionella spp., Pseudomonas aeruginosa and Mycobacteria spp. He worked closely with the Department of Health (DH England) and Health and Safety Executive in writing and developing national and international guidance on the microbiology of water and decontamination in healthcare.
Affiliations and expertise
Former Scientific Leader in Water Microbiology and Decontamination, Public Health England (PHE), Porton, UKSS
Susanne Surman-Lee
Dr. Susanne Surman-Lee (PhD) has over 35 years’ experience as Public Health Microbiologist having worked in both in clinical and public health microbiology within the National Health Service, University Sector and Public Health. Until 2010 as Director of the HPA London Food Water & Environmental Microbiology Laboratory (LFWE). Susanne has been involved in developing guidelines as author / editor at national and international level for many years including the WHO Legionella and Prevention of Legionellosis, WHO Water Safety in Buildings and many national and international standards including HSG274, HTM04-01, BS 8580 Legionella Risk Assessment, BS 7592 Legionella Sampling, and chaired BS 8680 Water Safety Plans and BS 8580 part 2 Risk assessment of P. aeruginosa and other waterborne pathogens. Susanne has also been involved in many hospital investigations into waterborne infections nationally and internationally.
Affiliations and expertise
Director, HPA London Food Water & Environmental Microbiology Laboratory (LFWE), UKPM
Paul J. McDermott
Dr. Paul McDermott, (PhD) has significant practical experience in occupational health and safety, specializing in the fields of biosafety and biosecurity, and incidental exposure to biological agents in workplaces. Before setting up PJM-HS Consulting Ltd in 2014, Paul gained 13 years' experience working as a Specialist Inspector in Great Britain's Health and Safety Executive (HSE). His specialist regulatory role in HSE's Biological Agents Unit involved undertaking inspections and audits, and enforcement of health and safety legislation. He has also been instrumental in the production of key national guidance documents in this field, including the review of the current Approved Code of Practice (L8) and its associated technical guidance (HSG274) and CIBSE’s TM13, BS 8580 (2010), BS 8580-1, BS 8580-2 and BS 8680. He has spoken at numerous governmental and industry-led forums and conferences, both nationally and internationally. Paul has a strong reputation in the effective management of waterborne infections, in particular Legionella and Pseudomonas aeruginosa. Paul has acted as expert witness in numerous legal cases and is Authorising Engineer (Water Safety) at several NHS Trusts.
Affiliations and expertise
Specialist Inspector, Great Britain's Health and Safety Executive (HSE), UKMW
Michael Weinbren
Dr. Michael Weinbren has been a consultant microbiologist and infection control doctor since 1990. Michael’s interest in water was originally stimulated whilst working at the regional burn centre at Queen Mary's University Hospital Roehampton. Michael was the DIPC at the University Hospital of Coventry and Warwickshire during the construction of the new hospital which started in 2001 and was completed in August 2006. Within nine months of opening there was a legionella contamination of the water systems and a pseudomonas outbreak on the neonatal intensive care unit originating from water systems. Michael is currently chair of the Healthcare Infection Society working party on water and presents nationally and internationally on different aspects of microbial waterborne pathogens.
Affiliations and expertise
DIPC, University Hospital of Coventry, UKRead Safe Water in Healthcare on ScienceDirect