An ‘Internet of Things’ (IoT) temperature monitoring system (such as LinkThru from Cistermiser) is designed to substantially reduce the workload of healthcare estates teams seeking to minimise the risk of Legionella growth, by eliminating the need for manual temperature recording and frequent flushing of outlets:
Intelligent temperature monitoring units connected to the IoT deliver a system for automatic wireless monitoring, providing real-time temperature readings on the user’s computer screen, in order to track and monitor hot and cold water temperatures in pipework systems which are critical to risk assessments.
IoT-enabled temperature monitoring unit was specifically designed to enable maintenance and engineering personnel responsible for large, complex water systems – such as those found in in hospitals – to continuously monitor hot and cold water temperatures within multiple buildings without having to visit sentinel points to measure temperatures manually. Instead an installed network of small ‘black box’ hardware devices can do the job automatically.
The battery-powered Temperature Monitoring Units (TMUs), each typically incorporating a lithium metal cell battery with a five-year lifespan, connect quickly and easily to the water pipe, TMV, or outlet, using small clamps. Their use eliminates the need for a healthcare engineer to take temperature readings using a probe or thermometer at sentinel points, usually weekly, record the data, and then email or manually input the data into whatever monitoring software ‘front end’ the estates department is using. Healthcare estates teams traditionally spend significant amounts of time manually checking and recording water temperatures.
The development of IoT monitoring solutions is primarily focussed on the need for careful monitoring of water temperatures to combat Legionella, as set out in Department of Health & Social Care and HSE guidance. As HTM 04-01 stipulates, the key challenge is centred on avoiding water temperatures that favour the bacterium’s growth, i.e. maintaining stored cold water temperatures at 20˚C or below, and hot water which leaves the calorifier at 60˚C and circulates at 55˚C. HTM guidelines lie at the heart of effective IoT monitoring – for instance in setting the software’s recommended default temperature ranges for certain outlet types. HTM and HSE L8 ACoP guidance also emphasises the need to ensure water doesn’t stagnate, and of accurate record-keeping. An ability to automatically monitor and record water temperature with minimal human intervention is one of the biggest cost and time-saving benefits cited by hospitals who have trial-installed a new connected temperature monitoring system.
Significant Resource Issues
Healthcare estates teams are good at undertaking risk assessments and water monitoring, but many large hospitals face a significant resource issue in sparing the staff to go around and take temperature measurements, let alone keep really accurate records. How many estates managers could, say, hand on heart, that their water temperature records are constantly 100 per cent accurate? However, if an issue arises, and accurate records cannot be presented to a regulator, this situation could lead to prosecution.
Currently in most large hospitals, an estates manager will either direct one of his or her own staff to tour the site, turn taps on and off, and take temperature readings, or may use an outside contractor to do the job. Electronic logging systems are available, but most require somebody to take readings. However, can the estates manager always be sure that the job is being thoroughly carried out?
An IoT monitoring device is designed to be retrofittable and fit onto a washbasin, any pipe with an access point, behind a panel, under a sink, on a sluice, or by your boiler. A typical TMU incorporates an aerial plus two ports to which cables are connected and then attached at the other end to the pipework or outlet, typically to a 15 mm or 22 mm pipe, using small push-fit connectors. With lagged pipework, using a Stanley knife to trim the insulation will expose the pipework sufficiently to enable a sound connection. The process is very quick and easy. Each port can take two readings, for instance the pipework leading to a hot and cold tap.
Immediately Taking Readings In Real-Time
A TMU hardware box can be affixed onto a pipe using a cable-tie or adhesive tape. Once attached it is ‘live’ and taking readings to monitor water system temperatures and flow events. For example, a sentinel point installation could be on a TMV, with a hot feed, a cold feed, and a mixed feed requiring three connections, or you might want to record data from a cold feed and a circulating hot return on your hot outlet, or you could just leave one connector fitted to record your ambient temperatures. A connected TMU typically takes a reading every 10 seconds, and then sends recorded temperatures up to ‘the cloud’ on an hourly basis, providing data including the maximum, minimum and average temperatures recorded over that period. The sensor also records any flow events, such as a tap being turned on, which will give a spike in temperature. The device’s inbuilt software analyses the data readings which are batched and sent to the ‘cloud’, and thence to the user interface. Some leading systems use the Sigfox network, which is a long range, low-power, low-bandwidth wireless technology that is well established across Europe and now rolled out across the UK. Sigfox is principally used for transmission of ‘Big Data’ around smart devices and machine-to-machine intelligence.
Prior to TMU installation, a site survey is always undertaken to check the strength of the Sigfox wireless signal. Should the Sigfox signal strength appear weak or ‘patchy’ in certain building locations, local boosters can usually be provided. TMUs usually operate with a choice of high and low fidelity modes, with the latter also designed for use should the battery be running low (the batteries typically have a lifespan of up to five years). If this happens, the system will alert the user. Sealed TMUs are designed to be replaced at the end of the battery’s life. The devices are simple to install and subsequently relocate, if necessary. A large acute hospital might ideally require very large quantities of TMUs, but in working practise there will always be a balance. The user initially invests in purchasing the hardware, and post-installation there is an additional monthly subscription fee to access the cloud-based software platform and analyse the data. The user, for example a Trust’s estates team, will need to determine what they are paying for their current manual temperature recording and water flushing methods, and how much value they assign to securing robust data on a continual 24/7 basis, together with ease of use and added peace of mind. Some sites will want to install a monitoring device on every outlet and with a large acute hospital this could potentially be tens of thousands of TMUs, but many smaller care premises may decide to fit them at selected higher risk sentinel outlets.
Web Accessed Portal
TMU users are allocated a password and ‘log in’, with no need to install special software on their PC, since all the data readings are held in the ‘cloud’ and accessed via an easy-to-use web portal. Once each device is registered, they can access data both from individual units and the main interface. Traditionally an estates engineer recording data across a sizeable building could have thousands of temperature readings to sort through, analyse, and, where necessary, respond to with remedial action each week. TMUs record temperatures automatically, only alerting the user if there is a problem. The software allows, say, a ‘master-user’, to create pre-determined rules for different outlets such as sinks or TMVs. Once fitted to a prescribed sentinel point, each TMU will then only send an alert – either directly to the user interface (which can be viewed on a PC, tablet or mobile phone), or to designated personnel via email – if a recorded temperature strays outside the specific parameters set for that type of outlet, or if water flow is low or non-existent over a preset period.
Entering Initial Data
During the installation process the engineer fitting the monitoring device simply needs 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 these details, 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.
In addition to enabling efficient, accurate, automatic temperature monitoring, the IoT-enabled TMU also eliminates the need for an engineer, or indeed, say, a designated nurse, to make a point of visiting well-used outlets to undertake water flushing, provided that the temperatures remain within preset parameters, as appropriate. The automatic IoT temperature monitoring 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. Installed TMUs will also help users to identify underused outlets or, for example, taps or showers left running. Recorded data readings can typically be integrated into a BMS or CAFM, and exported in file formats including Word, Excel, and CSV. No matter how big the hospital site might be, or how many buildings make up the estate, or how complex the water system, the constant monitoring data records will be easily viewable.
At any time, a user can see how many monitored sentinel outlets are presenting no risk, or ‘high’, medium’, or ‘low’ risks (temperature or flow-wise) and which are functioning optimally. By clicking on the user portal screen where an issue has been identified, the user receives a summary of what the issues are. For example, an estates manager user can easily view a handy list of all outlets where temperatures or water flows are presenting a potential risk. As the system is entirely web-based, the ‘master-user’ can assign which other users can access the system via a log-in, and to what level, and which colleagues will receive email alerts. Individual users can decide whether, in the event of an alert, it will only show if they access the management portal dashboard, or they may prefer for an alert to be emailed to them for viewing on their PC or mobile device. In an ideal scenario – where most outlets pose minimal Legionella risk – the user may never get an alert because their system is functioning perfectly but they may want to log in monthly and export a report which will give a summary of all activity for the last month.
When a flow event occurs, for example somebody running a tap for 30 seconds, an IoT monitoring system will typically imprint an electronic date and time stamp, and the current temperature, in a little ‘cube’ of information. By clicking on any flow event, the user can drill down for more detail. A TMU system user can view, in real time, the precise number of sites and buildings under their control and the fact that they might have 64 devices currently operating, with 5 outstanding alert issues that may require attention. An estates manager can look at their site, across each building and floor. They can see how many outlets they have, and what type. Looking at the men’s toilet on the1st floor of Building A they can see timeline readings over the past week on the 2 TMVs installed at that precise location, with drill-down details available of every activation and the temperature at the time. The range of temperatures can also be visually illustrated via a colour-coded graph. From such a portal view, for example, the records show that most activations of this particular TMV occur early in the morning or early evening, which might, for example, give an estates manager a good idea on the best times to send cleaners in.
Identifying Potential Problems
Time/date records of temperatures at a single hot water outlet, typically presented for the preceding week, will indicate the percentage of readings where temperatures have stayed safely within the preset range. If the hot water temperature at the outlet is falling below 45˚C, the estates team may need to investigate accordingly. Conversely, if analysis of the cold water temperature at the outlet shows stable recordings of between 7˚C and 20˚C, 100% of the time, this data would give reassurance. In another scenario, a TMU user might receive a ‘high’ risk alert because a cold pipe got too warm. The subsequent readings may identify that this issue resolved itself within 2 hours, but the software will raise a little tag to acknowledge on the portal interface screen, which won’t disappear until the user does so. If the alert remains unacknowledged, the system will continue to display a red flag icon. These visual management guides are invaluable tools for a busy healthcare estates team. Standard TMU profiles for outlet monitoring typically include a basin, a cold water tap, a hot water outlet, a tank, a calorifier, a TMV, an incoming mains, a riser cupboard, a shower, and internal pipework.
A TMU system user can produce an insightful report for every site and building they are responsible for, although they might just want to focus on one building or even a specific floor or hospital ward. Reports can be selected across a specified date period (for example, weekly or monthly), and the IoT monitoring software will then automatically generate a summary report on water temperatures at sentinel points and all flow events that have occurred. Accurate and detailed reports can be precisely tailored and are always readily available, when required.
When water temperatures are recorded by the traditional method involving flushing of water and use of manual probes, each sentinel outlet will typically have just one set of readings per month, while a TMU will record 259,200 sets of temperature measurements over the same 30-day period.
For more information about IoT monitoring from Cistermiser, please visit www.linkthru.com