What is a “Water Risk Assessment”? There are numerous hazards within the clinical water demise e.g.
• Scalding
• Slips and trips
• Chemicals
And a wide variety of waterborne organisms e.g.
• Legionella pneumophila and/or species
• Pseudomonas aeruginosa
• Mycobacterium chimaera
• Multi-drug resistant (MDR) organisms

Clinical literature is increasingly linking organisms to a wide variety of water-sources and new detection techniques are allowing precise analysis of a wider range of pathogens. There are some guidance documents available e.g. Legionella risk assessments are detailed within BS 8580-1:2019 and HTM 04-01 covers some other pertinent waterborne bacteria, but there is, more often than not, a disconnection between clinical, cleaning and engineering scenarios. There tends to be a blanket approach to Legionella risk assessments, most commonly not considering how patients actually interact with water, which leads to a disproportionate approach. Infection control teams perform useful audits, which again may give blanket statements regarding items of equipment, such as taps, giving a similar disproportionate approach. Cleaning services also perform audits, which can pick up highly useful information such as the formation of scale, blockages of sanitary-ware or observation of fluids being tipped into wash-handbasins.

The Water Safety Group is a multidisciplinary team that should have the knowledge and capability to review the various risk assessment and audit outputs in a contextual manner. They should be commissioning multi-disciplinary risk assessments for specific areas, items of equipment or patient groups. The resulting risk assessments and Water Safety Plan will thus fulfil the requirements of being living documents.

Elise Maynard, Independent consultant, water and medical devices