The Water Safety Group and its Role in Hospital Safety
Maintaining safe water systems is essential in any building, but in hospitals and healthcare settings, the stakes are significantly higher. Vulnerable patients, complex infrastructure, and specialist water uses mean that even minor issues can lead to serious health risks. To address these challenges, healthcare providers in the UK are required to establish a Water Safety Group (WSG) as part of their infection prevention strategy, as outlined in the Health and Social Care Act 2008 and the HTM 04-01 guidance.
This article explores the vital role of the Water Safety Group in hospital safety, from assembling a team of multidisciplinary experts to creating and managing a comprehensive Water Safety Plan. It covers who should be involved, what the group’s responsibilities are, how risks are identified and managed, and the importance of clear leadership and accountability. Ultimately, the WSG is central to ensuring water systems are safe, compliant, and capable of protecting the health of patients, staff, and visitors.
Maintaining water safety in healthcare settings
Water safety is crucial to get right in every building. However, there are specific requirements that are noted for hospitals and healthcare premises to keep patients, visitors, and workers safe. Under the Health and Social Care Act 2008: Code of Practice covering the prevention and control of infections and related guidance, healthcare providers must establish both a Water Safety Group and Water Safety Plan to effectively manage and monitor the control and prevention of infections.
To support this requirement at a practical level, the Department of Health has produced detailed guidance in the form of a Health Technical Memorandum or HTM called HTM 04-01, Safe water in healthcare premises. There are several parts to this document, but Part B focuses on operational management. This notes how important it is to construct a team of specialists with relevant knowledge and experience to form a Water Safety Group.
What is a Water Safety Group?
A Water Safety Group is a multidisciplinary team of experts created to commission, develop and then implement and manage a detailed Water Safety Plan to control and prevent water risks, and so achieve safe water supplies.
What is a waterborne pathogen?
This type of pathogen is noted many times in HTM 04-01, so it is worth covering it briefly here, before we go deeper in to the role of the Water Safety Group. The phrase typically refers to an agent or organism that can cause disease to occur when it finds a host. In this case, the pathogen will be transported via water. In healthcare settings, Legionella bacteria is of particular concern, along with Pseudomonas aeruginosa (Part C of the document focuses on controlling Pseudomonas aeruginosa).
Who should be in the Water Safety Group?
This specialist team typically comprises several individuals, all with specific experience that can aid in providing knowledge to help develop a Water Safety Plan. This is imperative in healthcare settings, where there are more likely to be people who are at greater risk of developing Legionnaires’ disease.
The idea behind the formation of such a team is to create a group of people who can identify all risks associated with the water systems used in specific healthcare settings. This could be a hospital, a home for the elderly, or similar location.
The nature of the Water Safety Group will depend on the nature and complexity of the location. There could be several people, each experienced in a particular area. For example, someone with experience in engineering and facilities management would be able to understand the nature of the water systems and the layout in use in the building. Few if any healthcare settings will have a simple layout – many older buildings may have extensions whereby the original water system has been adjusted or extended over the years.
One or more individuals involved in nursing the patients on the premises should also form part of the group. They will have the necessary experience to be able to identify who is at greater risk of developing Legionnaires’ disease and indeed experiencing complications from it. There may be several people in this respect, each from a separate department.
Accountability for the Water Safety Group ultimately rests with the statutory duty holder
Some healthcare settings may use water in different ways, too. For example, some provide aquatic therapy that would pose different risks when compared to more standard usage through taps and showers elsewhere in the building.
There are other examples too, such as those involved in infection control or microbiology. The WSG should comprise someone from each relevant area to help gain a bigger vault of knowledge to draw from.
What does a Water Safety Plan do?
The WSG will develop a detailed Water Safety Plan, covering everything from a comprehensive water risk assessment to various elements of risk management. The primary goal is to maintain a safe water system for everyone who uses it.
The Water Safety Group will identify all potential hazards posed by any area of the water system. This stems from conducting a water safety or Legionella risk assessment of the entire building. Once all hazards have been identified, the group will decide which steps ought to be taken to resolve those hazards.
While removal of each hazard is the ideal scenario, since it removes the risk associated with it, this is rarely suitable. For example, an infrequently used shower might still be required in some instances. Rather than removing it, a plan to regularly flush it through would reduce the risk to an acceptable level. This would then be adopted as a suitable control measure in that instance. Regular monitoring should also be noted as part of the Water Safety Plan. This process is repeated to ensure that all risks identified by the risk assessment are resolved.
What is included in a Water Safety Plan?
The development of a Water Safety Plan comprises several steps, including creating a team of experts as noted above. It should also fully describe the water systems present in the healthcare settings, while identifying all the hazards associated with it. It should set out the control measures for all the risks found and prepare suitable procedures for carrying these out.
Regardless of the size or complexity of the Water Safety Plan, it should be regularly reviewed to ensure it continues to be fit for purpose. Many healthcare settings do go through changes, and these could lead to new risks being created in the water system. For instance, a new extension may require an extension of the original water system. Conversely, if a room or area is demolished, there could be dead legs created where there were previously none.
What is the NHS Water Safety Plan?
You may have heard of the NHS Water Safety Plan, and the terminology does make it sound as if there is one plan for the entire NHS. As we’ve seen in this guide, however, it is not. Each individual healthcare environment or setting will compile its own Water Safety Plan. This will help identify and control all the risks that are connected to each specific location.
Rest assured that whatever sort of healthcare facility you work in, a combination of the Health and Safety Executives ACoP L8, HSG274 and HTM 04-01 provides documentation, advice, and support required to help the WSG compile a Water Safety Plan that works for that location.
Who should lead the Water Safety Group?
We’ve already mentioned how important it is that individuals with relevant experience and knowledge should become part of this group. Each will apply their expertise to help form the best approach to water safety within the healthcare setting.
However, there should be an individual at the head of the group. This should be someone with the right experience and qualifications to claim that role. They should have extensive knowledge and understanding of HTM 04-01 and the relevant guidance contained in HSG274 Part 2, which focuses on how to control Legionella bacteria in hot and cold water systems.
In some cases, an external adviser is the best person for the job. An Authorising Engineer (Water) can also perform the role. It is less likely that someone with the relevant knowledge will come from inside the healthcare organisation since it is a specialised role.
Who has accountability for the Water Safety Group?
Accountability for the Water Safety Group ultimately rests with the statutory duty holder, and this individual or individuals can vary depending on the specific healthcare provider. For example, it could refer to an NHS Trust or to its chief executive. In the case of a private healthcare facility, the owner of the facility would likely be the duty holder.
Whoever performs this role, they should be noted as the duty holder at the outset. Everyone in the Water Safety Group is responsible to this person or persons.
Roles and responsibilities in the Water Safety Group
No individual will have responsibilities that spread throughout the entire Water Safety Group. As we have seen, there are people who hold different amounts of knowledge in different areas.
For instance, one or more specialist head of department roles may join the group to provide knowledge of their area. Those in a renal unit, for instance, will have patients who are at an increased risk of developing Legionnaires’ disease should they be exposed to Legionella bacteria. The same might apply to those who have just had surgery or who have suppressed immune systems.
Someone working in the renal unit would have extensive experience of the risks of contaminated water supplies in that unit. However, they would likely not be fully aware of the different risks posed by contaminated water found in a surgical unit, for instance. Each would have their own area of expertise to contribute to the Water Safety Group. The same applies to risk management specialists, engineering and estates management professionals, and those involved in facilities management.
It is the overall combination of all those involved in the Water Safety Group that combine to make it stronger. Everyone should be aware of their role within the larger group and have a clear understanding of their responsibilities as well. This supports the group and helps guide the creation of the Water Safety Plan.
Maintaining safe water supplies in healthcare settings
Water safety is of paramount importance in all buildings, but there are added risks associated with healthcare settings. That’s why the HTM 04-01 documentation was created, to help healthcare providers and those working in this area understand what is required of them, and so meet their duty of care. Maintaining a safe water supplies is easier when you know what to look for, which risks are present, and how to manage them effectively. While there may be many risks in the average healthcare setting, there are logical ways to minimise them as much as possible, as well. That’s what the Water Safety Group is there to do.
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