HTM 04-01 training and temperature monitoring.

What does Health Technical Memorandum 04-01 say about temperature monitoring? The summary section of Part B states:

Therefore, a temperature control regime is the traditional strategy for reducing the risk from Legionella and for reducing the growth and colonisation of other waterborne organisms within water systems. To prevent growth of P. aeruginosa and other waterborne pathogens, controls are necessary to manage the water system before and after the outlet.

As with all control measures, temperatures should be monitored at regular intervals to verify effective control.

More information is given in paragraphs 7.3, 7.4 and 7.5

• 7.3   A temperature control regime is the traditional strategy to control Legionella and other waterborne pathogens. This will require monitoring on a regular basis. Frequencies are listed in Table 1.
• 7.4   Whereas many of the checks will, of necessity, require the use of separate thermometric equipment, some of the temperature checks can be carried out by continuous monitoring such as sensors and reporting systems (optionally linked to a building management system (BMS)). Where a BMS is used, it will be essential to ensure that regular calibration and physical tests are performed in accordance with the manufacturer’s instructions.
• 7.5   More extensive use of automatic sensors and reporting systems should be considered for surveillance of systemic temperature profiling. Sensors should be located throughout the whole hot and cold water systems to ensure they give representative temperature values.

A very good article on the subject of temperature monitoring, and the use of automatic sensors and reporting, is provided by the xiveillance company. Here at Commodious, being an online training company, we are more concerned with what HTM 04-01 says about training. 

HTM 04-01 and training.

A key component of the HTM 04-01 document is the setting up of Water Safety Group - WSG.

• 6.3 The WSG is a multidisciplinary group formed to oversee the commissioning, development, implementation and review of the WSP. The aim of the WSG is to ensure the safety of all water used by patients/ residents, staff and visitors, to minimise the risk of infection associated with waterborne pathogens. It provides a forum in which people with a range of competencies can be brought together to share responsibility and take collective ownership for ensuring it identifies water-related hazards, assesses risks, identifies and monitors control measures and develops incident protocols.

Having formed the WSG, one of the remits of the group is detailed in para. 6.9

• 6.9 A typical list of tasks assigned to the WSG would be to oversee adequate supervision, training and competency of all staff;

Further references are made to training in para. 6.21

• 6.21 With respect to physical, chemical and microbiological hazards, the WSP should incorporate adequate supervision, training and competency for all levels of staff including housekeeping staff and those employed by facilities management organisations;

And in sections 6.27 through to 6.30 training is specifically covered as an essential requirement of HTM 04-01.

Staff training and competence

• 6.27 The WSG should implement a programme of staff training to ensure that those appointed to devise strategies, carry out control measures and undertake associated monitoring are appropriately informed, instructed and trained. They should also be assessed as to their competency. It is also essential that they have an overall appreciation of the practices affecting water hygiene and safety, and that they can interpret the available guidance and perform their tasks in a safe and technically competent manner.
• 6.28 The WSG should review the competence of staff on a regular basis, and refresher training should be given; records of training attendance need to be maintained. Although training is an essential element of ensuring competence, it should be viewed within the context of experience, knowledge and other personal qualities that are needed to work safely. Competence is dependent on specific needs of individual installations and the nature of risks involved.

Water hygiene training

• 6.29 Individuals to whom tasks have been allocated (supervisors and managers as well as operatives) need to have received adequate training in respect of water hygiene and microbiological control appropriate to the task they are responsible for conducting. The training and competence assessment should be clearly defined and should include those responsible for simple housekeeping tasks such as outlet flushing and the cleaning of wash-hand basins, through to maintenance staff and up to individuals who define strategy and develop procedures.
• 6.30 It is important that any person working on water distribution systems or cleaning water outlets should have completed a water hygiene awareness training course so that they can gain an understanding of the need for good hygiene when working with water distribution systems and water outlets, and of how they can prevent contamination of the water supply and/or outlets.

The importance of training is further emphasised by detailing clearly what is expected of a water hygiene training course.

Water hygiene training

As part of helping to ensure the delivery of safe wholesome water at all outlets and preventing contamination, which may lead to healthcare-associated infections, it is recommended that healthcare organisations implement a water hygiene training scheme.

Consideration should also be given to integrating a health screening element into the training to help ensure those undergoing the training are not carriers of any waterborne diseases on the date of training and are aware of their responsibilities towards the water supply.

It is important that individuals are aware of their duty to protect the health of patients, staff and visitors and that they are responsible for ensuring that they inform their line manager if they come into contact with any disease that has the potential to cause harm.

The course should encompass the following topics (not exhaustive):

• organisational governance arrangements in relation to water hygiene and safety;
• familiarisation with local policies/ procedures in relation to the management and provision of water hygiene and safety;
• information on prominent waterborne pathogens and their consequences;
• the ways in which water distribution systems, water outlets, components and any associated equipment can become contaminated;
• the responsibilities of individuals to prevent the contamination of the water distribution system and water outlets and assisting in ensuring control measures in place are effective;
• how the safety of water can be maintained by good hygiene practices;
• when not to work with water intended for domestic purposes;
• system design;
• components/accessories (taps, TMVs);
• disinfection and cleaning equipment/ materials;
• how to store and handle pipes;
• organisation-specific control measures;
• the impact of getting it wrong;
• role of persons being trained;
• personal hygiene along with dealing with clothing, footwear, cleaning equipment/materials, tools and storage when considering water hygiene (as applicable to each role).

Conclusion

It is very clear that HTM 04-01 has training and competency at the very centre of it's recommendations for providing safe water in healthcare premises.

A legionella risk assessment in a healthcare setting should now cover waterborne pathogens such as Pseudomonas aeruginosa, Stenotrophomonas maltophilia, Mycobacteria as well as Legionella. HTM 04-01 makes clear that a risk assessment must be carried out by a competent person with suitable qualifications. Covered in detail by paragraphs 2.9 and 2.12.

The risk assessment will provide a written scheme of how to minimise the risks from Legionella and other waterborne pathogens. HTM 04-01 makes clear that implementing the scheme will require training and competency assessments of all staff involved with the scheme.

In large health care premises, such as hospitals and the like, this training will almost certainly have to be bespoke. In smaller premises such as health care centres, GP surgeries and day care buildings then a general water hygiene course may be all that is required.