Specialist Water Hygiene Support for Healthcare Environments

Water safety within healthcare premises requires a particularly robust approach.

Hospitals, clinics and other healthcare facilities may contain complex hot and cold water systems serving patients who are more susceptible to infection than the general population. This can include elderly patients, people undergoing treatment, and individuals who are immunocompromised or otherwise at increased risk from waterborne pathogens.

Source Water Compliance provides independent Legionella risk assessments and water hygiene consultancy for healthcare premises, including higher-risk clinical areas caring for particularly susceptible or immunocompromised patients.

Our assessments consider not only the condition and operation of the water systems, but also who may be exposed and the clinical environment in which those systems are being used.

Request a Healthcare Legionella Risk Assessment

Why Healthcare Water Systems Require Particular Attention

Healthcare environments differ from many conventional commercial buildings because the vulnerability of those exposed to the water can significantly affect the overall risk.

HSE guidance specifically identifies healthcare premises as high-risk locations where water systems require particular consideration. HSG274 Part 2 also directs healthcare premises towards healthcare-specific water guidance including Health Technical Memorandum HTM 04-01 – Safe Water in Healthcare Premises.

Potential areas and systems can include:

Patient bedrooms and bathrooms
Clinical areas
Wards
Treatment rooms
Isolation facilities
Higher-risk and augmented care areas
Showers
Assisted bathrooms
Staff welfare facilities
Kitchens and beverage points
Cold water storage tanks
Calorifiers and central hot water systems
Hot water circulation systems
Thermostatic mixing valves
Point-of-use water heaters
Expansion vessels
Water softeners and treatment systems
Low-use outlets
Redundant or little-used sections of pipework

Healthcare risk assessments therefore need to consider the water system, its condition and operation, the population being exposed and the location of individual outlets.

Healthcare Legionella Risk Assessments

Our assessments involve a detailed inspection of the hot and cold water systems together with a review of the site’s existing water safety management arrangements.

Depending on the facility, this may include:

Incoming Water Supplies

Identification of incoming mains water supplies and how water is stored, boosted and distributed throughout the premises.

Cold Water Storage

Inspection of cold water storage tanks including condition, configuration, temperatures, turnover and associated distribution pipework.

Hot Water Systems

Assessment of calorifiers, hot water generators, circulating systems, return temperatures and distribution throughout the building.

Patient and Clinical Areas

Consideration of outlets serving patient bedrooms, wards, treatment spaces and other clinical environments.

Particular attention can be given to locations where patients may be at increased susceptibility to infection.

Showers and Aerosol-Generating Outlets

Assessment of showers and other outlets capable of producing aerosols, including their use, condition, temperature and management.

Low-Use Outlets

Identification of outlets where poor turnover or intermittent use may increase stagnation risk.

This can be particularly relevant in:

Spare patient rooms
Temporarily closed wards
Consultation rooms
Treatment areas
Remote facilities
Rooms awaiting refurbishment
Areas affected by changing occupancy

Water Temperatures

Temperature measurements throughout representative parts of the water system to assess whether the existing temperature control strategy is operating effectively.

HSG274 Part 2 states that hot water should generally be stored at least at 60°C and distributed so that it reaches 55°C within one minute at healthcare outlets, while cold water should, where possible, be maintained below 20°C. The risk assessment must also consider susceptible people and scalding risk.

System Configuration

Identification of conditions which may encourage microbial growth, including:

Stagnation
Dead legs
Dead ends
Redundant pipework
Poor hot water circulation
Excessive pipe runs
Heat gain into cold water systems
Inadequately used outlets

Water Safety Management

Review of available documentation including:

Existing Legionella risk assessments
Written Schemes of Control
Temperature monitoring records
Flushing records
Tank inspection records
Cleaning and disinfection documentation
Sampling results
TMV maintenance
Shower cleaning
Corrective actions
Responsibilities and escalation procedures

Higher-Risk and Immunocompromised Patient Areas

Not all areas within a healthcare facility should necessarily be treated as having the same level of risk.

Some clinical environments contain patients whose underlying condition or treatment may make them particularly vulnerable to waterborne infection.

Source Water Compliance carries out risk assessments within higher-risk healthcare environments, including areas used by immunocompromised and particularly susceptible patients.

In these areas, our assessment can consider the additional significance of:

Patient susceptibility
Outlet location and use
Water stagnation
Temperature control
Biofilm development
Outlet fittings
Flexible hoses
TMVs
Shower equipment
Point-of-use controls
Water sampling history
Local clinical controls
Existing Water Safety Plan arrangements

The objective is to assess the water system in the context of the people actually being exposed to it, rather than treating every outlet within the building identically.

NHS England’s HTM 04-01 covers the management of Legionella, Pseudomonas aeruginosa and other waterborne pathogens in healthcare premises, while Part C includes additional measures for controlling Pseudomonas aeruginosa in augmented-care units.

Discuss Your Healthcare Water Systems

More Than Legionella

While Legionella remains an important element of healthcare water safety, healthcare premises may also need to consider other opportunistic waterborne pathogens.

HTM 04-01 specifically addresses the management of risks associated with Legionella, Pseudomonas aeruginosa and other waterborne pathogens. NHS England has also issued additional guidance concerning nontuberculous mycobacteria and other waterborne pathogens affecting patients at greatest risk of healthcare-associated infection.

This is one reason healthcare water safety should not simply be approached as a standard commercial Legionella assessment.

Working in Accordance With Healthcare Water Guidance

Our healthcare assessments take account of applicable guidance including:

HSE Approved Code of Practice L8 – Legionnaires’ disease

HSG274 Part 2 – The control of legionella bacteria in hot and cold water systems

HTM 04-01 – Safe Water in Healthcare Premises

HTM 04-01 provides guidance covering the legal requirements, design, maintenance and operation of hot and cold water supply, storage and distribution systems across healthcare premises and is intended to be read alongside L8 and HSG274 Part 2.

For healthcare organisations, this provides a much stronger section than simply saying the assessment is “HSG274 compliant.”

Practical Recommendations — Based on Clinical Risk

Our reports provide clear, prioritised actions following the site assessment.

Recommendations may include:

Improving temperature control
Investigating poor hot water circulation
Reviewing low-use outlets
Removing redundant pipework
Reviewing flushing arrangements
Cleaning or maintaining cold water storage
Reviewing TMV arrangements
Investigating excessive cold water temperatures
Reviewing shower cleaning regimes
Improving monitoring records
Reviewing sampling programmes
Updating the Written Scheme of Control
Reviewing control measures within higher-risk patient areas
Further investigation where system performance is unsatisfactory

Recommendations are based on the actual condition of the system, how it is operated and the susceptibility of those potentially exposed.

Supporting Healthcare Water Safety Management

Source Water Compliance can support healthcare organisations following the initial risk assessment with:

Legionella Risk Assessments

Detailed assessment of hot and cold water systems across healthcare environments.

Written Schemes of Control

Development and review of site-specific Written Schemes detailing monitoring, control measures, responsibilities and corrective actions.

Water Hygiene Audits

Independent review of existing water safety arrangements, records and control programmes.

Water System Schematic Drawings

Clear schematic drawings showing principal storage, generation and distribution systems.

Water Hygiene Consultancy

Independent support for unusual findings, system changes, refurbishment works, microbiological results or areas of increased clinical risk.

Review of Higher-Risk Areas

Focused review of water systems supplying areas occupied by particularly susceptible or immunocompromised patients.

Healthcare Facilities We Can Support

We can provide Legionella and water hygiene support for:

Hospitals
Private hospitals
NHS healthcare premises
Clinics
Treatment centres
Community healthcare facilities
Specialist healthcare facilities
Rehabilitation centres
Diagnostic facilities
Mental health facilities
Dental and outpatient facilities
Healthcare estates
Multi-building healthcare campuses
Facilities management companies responsible for healthcare premises

Independent Water Hygiene Consultancy

Healthcare water safety decisions can have significant operational and clinical implications.

Our role is to provide independent, evidence-based assessment of the water systems and clear, proportionate recommendations.

We focus on identifying the actual risk present and helping estates and facilities teams understand what needs to be controlled, investigated or improved.

Arrange a Healthcare Legionella Risk Assessment

If you are responsible for a healthcare facility and require a Legionella risk assessment, review of your existing water hygiene arrangements or specialist support within a higher-risk clinical environment, speak to Source Water Compliance.

We can discuss the facility, patient population, water systems and existing control arrangements to determine the appropriate scope of assessment.