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Article: Why Water Temperature Is Vital In Healthcare

It’s the kind of news story which sends a shiver down the spine of anyone in charge of health and safety in a hospital setting. Back in 2017, an outbreak of Legionnaires’ disease in a Lisbon Hospital killed 4 people and made another 40 people sick. It was a clear example of why maintaining safe water systems should be seen as a high priority for healthcare premises of all kinds. The latest IoT monitoring technology (such as LinkThru from Cistermiser) can help to reduce the risks for all concerned.

Legionnaires’ disease, and other forms of waterborne infection, present a clear danger in hospitals. These diseases can have serious implications for anyone, regardless of age or physical robustness, but can be particularly debilitating for people suffering from other underlying health conditions. Maintaining water quality to protect patients and staff is crucial, but difficult.

Waterborne Infection

One of the key weapons against a disease such as legionellosis is temperature control. The bacteria can only proliferate in water temperatures between 20°C and 45°C. A straightforward way to control risks of infection, therefore, is to control

its temperature. The HSE advises ensuring that all stored hot water is kept at 60°C and delivered at 50°C, while cold water should be stored at 20°C. It sounds straightforward, but, in a large and complex environment, ensuring temperatures don’t stray into the danger-zone, is difficult.

The HSE recommends a full risk assessment and continuous monitoring of water storage and outlets for signs of blockages or corrosion. Tanks should be inspected regularly and cleaned where necessary.

The first problem is the drain on resources. Staffing levels in the NHS have become critical. A report from the Nurses and Midwifery Association found that 35,363 nurses left the profession between October 2016 and September 2017. Although the Department of Health was at pains to stress at the time that this represented just 0.2% of the total number of nurses working in the UK, this statistic backed up research from the King’s Fund earlier in 2017 which predicted that the number of working nurses would fall for the first time since 2013.

The talent drain is partly down to uncertainty surrounding the status of EU nationals since the Referendum, but it is also down to a flight of UK nationals driven by stress, and poor pay.  In 2017 a report found that nurses were quitting to work in supermarkets because of low pay. An organisation representing NHS Trusts in England said a significant number of hospitals had reported lower paid members of staff leaving to work in supermarkets.

“It’s worrying that we are seeing a continuing rise in nurses and midwives leaving the register and our data is clear that this is being driven by both UK and EU registrants,” said Jackie Smith, Chief Executive and Registrar of the Nurses and Midwifery Association. “These figures continue to highlight the major challenges faced by the UK’s health and care sectors around the recruitment and retention of staff. Nurses and midwives work incredibly hard in very difficult circumstances. Those responsible for workforce matters will no doubt respond to what these trends are showing.”

A Question of Cost

Staffing issues go hand in hand with the question of cost. The NHS faces an environment in which demands on its services are increasing exponentially. The population is growing – not just in terms of numbers, but also the average age. According to the Office of National Statistics, the UK population is projected to grow by 4.1 million by 2024. The fastest growing group of people will be the over sixties, which will increase by 20.4% over ten years and by 60% over the next 25 years. That’s good news in many ways and testament to the gigantic strides made by healthcare over the decades. However, this demographic trend will place an enormous strain on health services as more people will be living with long term and complex conditions.

At the same time, funding has failed to keep pace. The NHSE had said it needed £4bn to meet its key targets. However, only £1.6bn was provided prompting them to warn that these targets would be missed. In summer 2017, the British Medical Association claimed that the Government was deliberately underfunding the NHS to speed up privatisation. The Government refuted this claim, but the long-term problem and undeniable truth is that finances are failing to keep pace with demand. This has two important implications:

  1. Maintaining adequate infection control is more difficult. As organisations battle to manage shrinking budgets and staffing levels, the risk of infection inevitably rises.
  2. It is more important than ever to avoid infection – not just to improve safety, but to avoid the impact of financial penalties.

The NHS is also struggling under a rising level of legal expenses. Earlier in 2017 a report by the Medical Protection Society found that the £1.5bn annual cost of settling negligence claims could double by 2023. Despite the number of claims falling, the total cost had risen because of the size of claims themselves. An entire industry has arisen dedicated to claiming compensation for medical negligence. Patients are increasingly aware of their rights, and firms are working hard to push up the value of individual claims.

In such an environment, it becomes increasingly important to reduce the likelihood of infection arising and, also, to demonstrate compliance, which is why healthcare organisations are looking to update their temperature control processes. Using existing approaches, it is difficult to ensure that temperatures remain in the correct zones all of the time. Few managers would be able to say, with 100% certainty, what the temperatures of all water stored was at any given time.

A High Tech Solution

The solution lies in technology. Sophisticated IoT monitoring devices can relay water system temperature and flow event readings to a secure cloud-based management portal, constantly and immediately. This gives managers an instant view of the current state of play and empowers them to make better decisions. They can reduce the resource allocation of inspection and cleaning and enable estates management teams to correct issues much more quickly. Another key advantage with monitoring technology is that it is much easier to prove compliance with regulations. Accurate and concise data about the water system temperatures and any remedial actions taken can be retrieved quickly and delivered to regulators.

The technology to do this is available, but not yet widely adopted across the healthcare sector. Cross-organisation awareness is patchy and hospitals may be wary of the cost and processes involved with implementation. However, the rewards can be profound. These systems offer wins on multiple fronts – they make it easier to gain a real-time view of water temperatures to ensure compliance and reduce the cost and work involved with monitoring the water system. They may involve an initial expense, but these are systems which will pay for themselves rapidly.

For more information about IoT monitoring from Cistermiser, please visit

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