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A digital water management revolution

David Meacock, Technical Director at sustainable water management solutions’ specialists, Cistermiser, explores how the evolution of water temperature monitoring systems harnessing the Internet of Things (IoT), is helping improve patient /building user safety, estate efficiency and offers the potential to save the healthcare sector £millions per year. #


Nobody is in doubt that the next decade will see a technological revolution – in the treatment and diagnosis of disease – from managing depression through wearable technology, monitoring and treating asthma with smart inhalers, to giving diabetics more control over their condition thanks to automated close loop insulin delivery. The speed with which cloud technology is being adopted to provide solutions at every level within the healthcare sector is astonishing. Cloud technology is also being deployed across many facilities across the UK to monitor water quality, especially in the wake of the Pandemic. Remote IoT monitoring of water system temperatures and flow events can play a key role when building, re-commissioning or repurposing buildings that have been temporarily mothballed in order to manage building occupancy levels safely in light of flexing demand – e.g., to reduce the risk of legionella. In a broader context, although controlling the temperature of water has long been at the heart of anti-infection strategies, it has often been held back by an inability to gain a truly accurate real-time view of water temperature. That is changing thanks to a generation of digital technologies which promise to revolutionise temperature control being commissioned in numerous commercial and healthcare facilities across the UK.   

The sheer scale of the challenge  

While healthcare estate teams are competent at undertaking risk assessments and water monitoring, many hospitals face significant staffing issues and are therefore unable to spare staff to undertake such temperature monitoring. It’s not a lack of willingness or ability, just the sheer scale of the job when done manually. Healthcare estate engineers or even designated nurses are sent to attend washrooms and turn taps on and off at well-used and under-utilised outlets, take temperature readings using a probe or thermistor at sentinel points each month, or perhaps even on a weekly basis, record the data, and then email or manually input the data into whatever collation method the organisation is using, such as an electronic log-book. Putting this in context, an estate engineer who is recording the data could have thousands of temperature readings to sort through, analyse and where necessary, respond to with remedial action each week.  

Not only is this strategy open to human error, but inordinate amounts of time are spent by staff who could be otherwise more valuably engaged – and the whole staffing issue could worsen if we continue to see the skills gap widening as we continue to lose resource from the sector. But the worst case scenario of getting things wrong, in addition to time and cost, is the very real threat of legionella outbreaks in buildings that are already housing sick and vulnerable people.  

What is TMU water monitoring? 

In short, intelligent Temperature Monitoring Units (TMUs) deliver automatic wireless monitoring, providing real-time temperature readings on a computer screen, in order to track and monitor hot and cold water temperatures in pipework systems which are critical to risk assessments. A connected TMU can be retrofitted and is typically fitted onto water outlet pipework such as taps, distribution pipework including risers, calorifiers, cold water storage tanks and many other sentinel points across a building’s water system.  

As an example, our IoT enabled temperature monitoring unit LinkThru TMU was specifically designed to enable maintenance and engineering personnel responsible for large, complex water systems, to continuously monitor hot and cold water temperatures within multiple buildings, without having to visit sentinel points to temperature sample manually. Instead, a network of small ‘black boxes’ periodically monitors automatically. At any juncture you can see how many outlets are being monitored, how many are presenting no risk, a ‘high’, ‘medium’, or ‘low’ risk, temperature or flow-wise. Managers receive real-time information on the temperature of the water. They can instantly log whether it remains 100% safe and raise an alarm if the readings stray, and are causing a concern. 

How does this intelligent technology work? 

Each TMU device takes a reading every ten seconds and then sends the temperature and flow event data to a cloud-based portal at variable times. Recorded data includes maximum, minimum and average temperatures. The sensor also records any flow events, such as outlets being utilised. The data readings are analysed by the device’s inbuilt software, batched and sent up back to the cloud and then on to the user’s preferredinterface e.g. phone, tablet or PC. The accurate data delivered by the installed TMUs, identify sections of a building’s water system where safe water meets specific parameters (and therefore does not require excessive flushing) It also highlights areas that may require attention. In premises where TMUs have been installed, constant real-time IoT monitoring will show if flushing has been carried out correctly and appropriate hot and cold temperatures are being reached. Over-stretched technical resources can then be deployed selectively to address specific issues that may have been identified. Building owners and Estates Facilities Management teams both benefit greatly from this increased awareness, as well as added peace of mind.  

The power of data  

However, it’s the accuracy of the data and the intelligence of the solution where the system truly shines. Legislative requirements are of course a primary benchmark – in developing the system, we continually referred to HTM guidelines, in setting the software’s recommended default temperature ranges for outlet types. HTM and HSE L8 ACoP guidance also emphasises the need to ensure water doesn’t stagnate and of accurate record-keeping. This means Linkthru TMU users have the confidence that they’re accurately monitoring and recording what they need to in order to best protect against the threat of Legionella.   

However, the system goes way beyond this to provide previously inaccessible information in real-time and for those who want to really maximise use of the data, reports can be set up to indicate how water is (or isn’t) being used in specific rooms and extrapolating this one step further, can profile user behaviour to deploy optimal resource solutions.  

For example, if a report shows that most of the activations of a particular TMU are early in the morning or early evening, this may give an estate manager a good indication on when to send cleaners in or schedule water quality sampling at appropriate times. The automatic temperature monitoring facility not only detects temperatures which could lead to Legionella colonisation, but also those that might pose a scalding risk, or conversely a risk of pipes freezing. It also helps users identify under-used outlets or, taps or showers which have been left running.  

“The emerging technologies that permit remote sensing and monitoring of water temperatures and outlet usage undoubtedly provide significantly more data and superior information on water system safety compared to traditional approaches. The ability to check these important parameters in real-time provides a far more detailed picture of the way a water system is functioning and can identify issues such as infrequent use of outlets, to enable appropriate action to be taken, e.g., proactive flushing or outlet removal. Enhanced monitoring is likely to be of greatest value in high-risk areas, e.g., hospital augmented care wards, but can also be of great value during commissioning and balancing of new or altered water systems.  In these (and other) situations, the ability to appraise water flow (and usage) through a system can identify potential problems that might otherwise go undetected if traditional methods are used.  

“It has been said that knowledge is power, and that is certainly true; knowing what the problems are and the ability to locate the issue means that solutions can be implemented, and the situation resolved.   

“However, organisations that utilise these new technologies must do so in the knowledge that once problems are identified, there is an obligation to take proportionate actions to ensure corrective action.  Having systems in place to understand and utilise effectively the additional information that these intelligent solutions provide, is only part of the jigsaw, providing the required resource for both the short and long term), is essential.”    

Dr Paul McDermott FRSPH, FIHEEM   

“At Northampton General Hospital NHS Trust we are constantly striving to achieve value through technology engineering. This is through a combination of existing technologies, such as BMS systems alongside other technology such as LinkThru TMU. New technology can provide vital data at a fraction of the cost of existing hard-wired systems.  

We had a common problem which many Trusts face, in providing assurance of water system compliance to HTM 04-10. We needed to complete daily and weekly monitoring of incoming, stored and supplied water temperatures from our bulk storage tanks at point of use. 

“The hospital’s’ 45 acre site comprises of an estate which was built from between 1750 to 2018, so it’s technically challenging in terms of distribution network with 22 cold water storage tanks. We have a limited labour resource to provide assurance of testing, so the LinkThru TMU was immediately of interest. It was demonstrated to us for sentinel monitoring, but we quickly realised that this could be a solution to resolve our water temperature issue. Working with Cistermiser we used the LinkThru TMU system to monitor our tanks and were able to track our water usage versus storage temperatures over 24 hours with full history. We soon discovered that we had storage and temperature issues and we are now in the process of adjusting our stored capacity to achieve HTM 04 compliance.  

“In terms of installation, the process was simple and Cistermiser provided full training to our engineers to enable them to understand and install the technology in-house. This ensured it was expandable, as we progress along our journey with Cistermiser. The Trust IT department have been fully supportive of the scheme, as it is a stand-alone system using SigFox technology, so it does not sit on or influence the Trust IT systems. I would have no hesitation in recommending this solution and would encourage other Engineering Managers to adopt this innovative technology to aid compliance assurance.”  

Paul Braddock, Estates Maintenance Manager, Northampton General Hospital NHS Trust  

IoT water monitoring is a completely new approach for the healthcare sector, so it won’t become universally adopted overnight, but trends indicate that use of the cloud is becoming mainstream. With safety, efficiency and cost reduction all key priorities at the heart of the sector, the benefits of remote water monitoring from solutions like LinkThru TMU all indicate that the future of this sector really does lie in the clouds.  

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