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Article: LinkThru TMU Water Temperature Monitoring In Action

The evolution of Internet of Things (IoT) water temperature monitoring systems (such as LinkThru from Cistermiser) is helping improve patient safety, estate efficiency and offers potential to save the healthcare sector £millions every year.

Nobody is in doubt that the next decade will see a revolution in the treatment and diagnosis of disease. We’re already seeing how the Internet of Things (IoT) is opening up a world of possibilities in medicine, from managing depression through wearable technology, monitoring and treating asthma with smart inhalers, to giving diabetics more control over the condition thanks to automated close loop insulin delivery. The speed with which cloud technology is being adopted to provide solutions at every level of the healthcare sector is astonishing, so it’s no surprise that water management specialists like Cistermiser are embracing this technology to help facility and estates’ professionals gain real-time control over their water management.

As with any innovation, getting full scale adoption overnight is not realistic and a process of building awareness and education is vital and to be expected, especially when it comes to technology. Research supported by The King’s Fund and the Nuffield Trust found that although technology has the potential to deliver significant savings for the NHS, the service doesn’t have a strong track record in implementing it at scale and needs to get better at assessing the benefits and feasibility of implementing new technology. But with the increasing demands on funding, trusts are now having to seriously confront these challenges. I believe it’s a question of future proofing and learning from past mistakes.

No-one likes to think about the worst-case scenario, but there’s a reason it’s so important to track water temperature consistently in a hospital setting. In 2013, Basildon Hospital was fined £350,000 after two patients had previously died through exposure to Legionella. During the case, it was revealed that the hospital had been battling the bacteria for up to fifteen years, spending substantial amounts of money each year on maintenance of water management systems. The hearing found that shower heads and thermostatic valves had not been properly cleaned after the cleaning budget had been cut. Attempts had been made to control water temperatures with super-heated pipes. The problem that can then occur is that the pipes can inadvertently warm adjacent cold water supplies, allowing the cold water to slip into the dangerous temperature range where bacteria can proliferate.

Plugging The Gaps

While it’s essential that we learn lessons from episodes such as this, the key issue to flag is that if there is a shortage of accurate data to hand, it is almost impossible to identify that water temperatures are out of range across a large-scale hospital site which may have thousands of water system outlets to monitor.  Despite its critical function, water management in large-scale hospitals and health estates has traditionally been perceived as a problem-child, approached in a fragmented and sometimes inconsistent way across the sector.

While healthcare estates teams are good at undertaking risk assessments and water monitoring, many large hospitals face a significant resource issue in sparing the staff to go around and take temperature readings. It’s not a lack of willingness or ability, just the sheer scale of the job when done manually. Healthcare estates engineers or even designated nurses are sent to tour 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.

Traditionally an estates engineer recording 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 lose resource due to Brexit. 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.

Harnessing The Internet of Things

The latest innovation that’s already changing how hospitals are managing water systems, is an operating system comprising physical hardware connected to a cloud-based IoT portal. LinkThru TMU delivers automatic wireless monitoring, providing real-time temperature readings on their computer screen, in order to track and monitor hot and cold water temperatures in pipework systems, which are so critical to risk assessments.

Each connected ‘black box’ temperature monitoring unit is designed to be retrofittable, and to fit onto washbasin pipework, any pipe with an access point, behind a panel, under a sink, on a sluice, or by a boiler and is powered by a lithium metal cell battery with a lifespan of 3-5 years.

The unit takes a reading every ten seconds, and then sends temperature and flow event data to the cloud on an hourly basis. Recorded data includes maximum, minimum and average temperatures. The sensor also records any flow events, such as taps being turned on. 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 interface which might be a phone, tablet or PC. The system currently uses the Sigfox network, a long range, low-power, low-bandwidth wireless technology which is advantageous because it employs stand-alone radio signalling with no disruption to an organisation’s LAN of Wi-Fi.

Knowledge And Control At Your Fingertips

In developing the perfect marriage of cloud-based data storage and analysis technology to robust, specialist hardware for remote sensing and monitoring of water temperatures and outlet usage, the development aim is to counter each of the challenges that currently face healthcare estates teams: to ease the burden on time and labour and to eliminate the potential for human error.

However, it’s the power of the data, the knowledge part of the solution where the LinkThru system truly comes into its own. Legislative requirements are of course a primary concern – HTM guidelines were continually referred to, for instance, 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 users have peace of mind that they’re monitoring and recording what they need to in order to best protect against the threat of Legionella. But the system goes way beyond this to offer 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 or wards and extrapolating this one step further, can profile user behaviour and deploy optimal resource solutions. For example, if a report shows that most of the activations of a particular TMV are early in the morning or early evening, this may give an estates manager a good idea on when to send cleaners in or schedule water quality sampling at appropriate times.

Powerful Insights

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 will also help users identify under-used outlets or, for example, taps or showers left running. If the personnel flushing outlets on the 4th floor have forgotten to shut off the taps, then LinkThru TMU will detect this. If the hand sanitisation washbasin in an Augmented Care Ward is not in regular use by nursing staff, LinkThru TMU will detect this lack of activation.

Nigel Fawcett M.W.M. Soc, Support Services Manager for the Water Safety Division at Zeta Compliance Services Ltd, gives some feedback regarding LinkThru TMUs in action:

“We have started to roll out this technology with tremendous results and we look forward to installing this system into more client sites. We use LinkThru TMU due to the quality of the information it gives and the improved efficiencies this leads to, not only to monitor temperatures but also show the water system is being flushed. The ease of installation and level of information this gives to our clients is excellent. Also the ability to move the units around to different parts of the water system is an advantage.”

Helpful Alerts

The majority of users will want the system set-up to alert if there is a problem, then send an alarm notification as appropriate. At any juncture users and managers can see how many outlets are being monitored, how many are presenting no risk, a ‘high’, ‘medium’, or ‘low’ risk, temperature or flow-wise, and which are functioning optimally. By clicking on screen where an issue is identified, the user receives a summary of what the issues are.  Estates personnel can, for example, easily bring up a list of all outlets where temperatures or water flows are presenting a potential risk. Equally, individual users can decide whether, in the event of an alert, it only shows if they access the main dashboard, or is emailed to them via their mobile device.

In an ideal scenario – where most outlets pose minimal Legionella risk – users may never get an alert because the water management system is functioning perfectly. A user might want, however, to log in monthly and export a report which will give a summary of all activity for the last month. The range of temperatures can also be illustrated via a colour-coded graph. These are invaluable tools for a busy healthcare estates team. Once the data is recorded it can be integrated into an organisation’s CAFM, compliance software system or exported as required. The interface is designed so that no matter how big the hospital site, and how many buildings are involved, the overarching data readings are easily viewable.

Implementing The Technology

So how does this cloud-based IoT water management system work in practical terms for a healthcare estates team? There are 3 key implementation steps:

  1. The first step is an on-site survey which will check out the Sigfox signal strength and where required, boosters can be integrated into the system.
  2. The client orders the required IoT monitoring hardware, and there is then a monthly subscription fee to access data via the cloud-based LinkThru portal. Users are allocated a password and ‘log in’, with no need to install software on their PC, since all the data readings are held in the cloud and accessed via a simple web interface.
  3. During the installation process the engineer fitting the monitoring device needs simply to enter data on the type of outlet, its location building/floor number etc., and its ‘unique ID’, into their phone or PDA. The software then registers all this data, enabling a precise record to be maintained of temperatures and flow ‘events’ at every device. Once this is done, monitoring begins immediately, and, provided no alerts are generated for that particular outlet, there is no need for the engineer to re-visit it.

Any new technological solution can only operate to its optimum if users are aware of how best to use it. While the LinkThru remote monitoring system is intuitive to use and set up to suit every individual client, applications training according to specific site requirements is a core part of the solution. Parameters are mutually agreed and set up to meet client needs, these become the default and no settings will need to be altered – although they are easily editable if and when requirements change. “How To…” guides and videos are offered online, designed to help users install the system and obtain all the benefits, entirely self-sufficiently.

A Major Healthcare Site

Paul Braddock, Estates Maintenance Manager at Northampton General Hospital NHS Trust, describes the rationale behind selection and implementation of LinkThru TMUs for his organisation:

“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 new technology such as Link Thru TMU. New technology can help to provide vital information at a fraction of the cost of existing hard wired systems.

“We had a problem faced by many other Trusts in providing assurance of water system compliance to HTM 04-10. We needed to complete daily and weekly monitoring of incoming, stored and supply water temperatures from our bulk storage tanks to point of use.

“The hospital sits on a site of 45 acres and comprises of estate from years 1750 to 2018, so is technically challenging in terms of distribution network with 22 cold water storage tanks. We have limited labour resource to provide assurance of testing so the LinkThru TMU was immediately of interest. It was promoted to us for sentinel monitoring but we quickly realised that this could be an answer to the water temperature problem. Working with Cistermiser we used the LinkThru TMU system to monitor our tanks and were able to trend our water usage versus storage temperatures over 24 hours with full history. We soon discovered over storage and temperature issues and are 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 makes it 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 product and would encourage other Engineering Managers to adopt this new technology to aid compliance assurance.”

In The Clouds

IoT water monitoring is a completely new way of thinking for the healthcare sector, so it won’t become universally adopted overnight, but trends indicate that use of the cloud is becoming mainstream. According to research by Forbes, cloud-based computing spending has been growing at 4.5 times the rate of general IT spending since 2009, and is expected to grow at faster than 6 times the rate of IT spending by 2020. With safety, efficiency, cost reduction and evidencing all key priorities at the heart of the sector, the benefits of remote water monitoring solutions like Linkthru all indicate that the future of this sector really does lie in the clouds.

For more information about IoT monitoring from Cistermiser, please visit

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