Practical strategies to improve water systems in hospitals

International water standards for hospitals have been established since 1958, ensuring purified water of a specified quality is delivered to the point of use. From sterilising medical instruments and decontaminating hands to lab experiments and dentistry, water has many uses in today’s hospitals.

Quality water supply to healthcare facilities is not only essential for safe patient care – it also presents a manageable source of healthcare-associated infections (HAI). In many low to middle income countries where quality standards are still unmet, HAI outbreaks from water sources are not uncommon. Infrastructure is often damaged or inadequate, contaminated through broken water systems.

As a global engineering partner in the life sciences sector, we recognise the undisputed importance of water purification systems which include devices, associated piping, pumps, valves and gauges.

Looking through a global lens, we’re seeing regulatory change in Australia.

Here’s what’s changing…

Australia: AS/NZS 4187 superseded by AS 5369: 2023

In December 2023, AS/NZS 4187 was superseded by AS 5369 Reprocessing of reusable medical devices and other devices in health and non-health related facilities.

This change broadens the scope of reprocessing water quality and risk management system requirements, requires segregated reprocessing environments and places greater emphasis on the requirement for suitably qualified and competent personnel to be engaged for validation, quality and operational tasks.

There are implications in the new standard for Central Sterilisation Services Department (CSSD) facility design, specification and validation including the documenting of water as an ‘agent involved in reprocessing’. Process maps or flow diagrams of CSSD systems, including water purification, are mandatory and to be used in a formal risk evaluation and management system. The developed risk assessment is then recommended to be reviewed annually or whenever a change is made to the process.

The case for improving water system plant life – looking through a global lens

Around the world, hospital water units and systems can have a limited expected plant life of ten years. System replacement becomes necessary once routine sanitisation cycles become less effective against the build-up of biofilm.

Increased frequency of chemical sanitisation and thermal disinfection become necessary to counter the effects of an established biofilm and meet regulatory compliance requirements for water quality. Poor water quality performance and unscheduled maintenance events therefore increase the operational costs of the water system and raise questions about system reliability.

Patient outcomes are known to improve with the quality of the water used in renal dialysis and the CSSD processes for reusable medical devices and endoscopes.

Avoiding the build-up of biofilm through investigation of compliance issues, system performance issues and a focus on addressing their root causes can support an improved plant life.

Practical strategies to benefit water system performance

While we may be seeing regional regulatory standards change in certain regions, we believe best practice is international.

We’ve outlined practical strategies that hospital water system owners can use to prioritise maintenance activities and improvement projects, benefitting system performance, patient outcomes and sustainability.

1.  Start at the source: monitoring water quality

Monitoring starts at mains water connection. The chemical, microbiological and physical properties of the feed water will have seasonal variation. Consequently, this has an impact on the performance of the water purification equipment.

Regular sampling and water quality data collection throughout the water system, including incoming water supply at each step of the purification process and at the user outlets, are essential to identify trends and early indication of performance issues. Whilst the water quality requirements for a dialysis ward will be different to the CSSD, we can use the same methodical approach for investigation and troubleshooting any excursions from the acceptable quality limits.

But how and where can you gather water quality data?

This step requires input from several sources and a supportive open path of communication with maintenance contractors, suppliers and internal customers or medical departments. For a holistic view of RO water system performance, you’ll need to engage with the right people.

In this example, the indirect impact to patient is mild in the short term but becomes moderate as the biofilm develops and the hazard persists. System availability may be compromised in the long term by increased sanitisation frequency as fouling of the RO membranes starts to impact system performance.

In both the short term and long term, the risk score ranking for stagnant water in the pre-treatment piping is categorised a severe high risk (15-30) as defined in AS 5369 Appendix B. The piping dead leg risk is consequently required to be documented and the control measures in place to manage the defined risk and the assigned corrective actions. The ranking of identified hazards in the established risk assessment document becomes a guide to the prioritisation of maintenance budget expenditure and justification for capital improvement projects.

3.  A win-win: creating a more sustainable system through improved compliance

Risk evaluated priorities for improved compliance and performance can also make RO water systems more sustainable. The key aspects of sustainability applicable to RO water systems are water efficiency, waste and materials.

In conclusion

The introduction of mandatory risk assessments for the performance monitoring and maintenance of CSSD system, as required by AS 5369: 2023 in Australia, is an opportunity for facility owners to proactively manage water system performance.

Using the risk assessment framework to capture findings from regular review of water quality data allows for the prioritisation and allocation of budget to improvement projects that return the greatest benefits.

Whilst the objective is to improve water quality compliance and patient outcomes, there are measurable sustainability benefits with improved water efficiency, extended plant life and reduced consumption of chemicals and replaceable components.

We place sustainability and reliability at front of mind when designing water systems for leading life science and pharmaceutical companies. Our meticulous, thorough designs and predictable, reliable project delivery are what make us a partner of choice to many hospitals and Government health departments across the globe.