Copper and silver ionisation Legionella control system is “a blessing”
Monthly water samples across two hospitals with historic, complex water systems, now show reassuringly clear results. A far cry from the situation four years ago, as Claire Hennessy, operational head of estates at Oxford University Hospitals NHS Foundation Trust, tells Hospital Times.
“When I first came here, a lot of the water sampling was done in-house,” says Claire. “It was not being done correctly and not in a UKAS laboratory. We decided we needed an accredited UKAS lab and the correct bottles for sampling.
“That was when we started to get Legionella positives across the site and a range of CFU counts. There were basically the three rules: keep it clean, keep it flowing and keep the temperature correct.”
“At the time, we had positives across both Churchill Hospital and the John Radcliffe Hospital. We had a chlorine dioxide system at John Radcliffe, which was doing nothing.”
“The trust’s Churchill Hospital is mainly post-war era, single storey. In areas such as the hospital’s head and neck ward we had to take showers out of use. At one time, we only had one shower that could be used. It was a real concern.”
Claire explains: “We knew we had to have a system which would help us to manage the water systems of our historically aged estates with all their many issues. We needed a system that had the potential to prevent Legionella.
“Ricky Mujaji, our senior estates operational manger, went to the first L.E.A.P (Legionella Environmental Action Platform) event. He came back and told us about ProEconomy’s copper and silver ionisation system, which we thought was still a disallowed system under the European Directive.
“ProEconomy presented the paperwork which showed that it could be used and information on the system’s use at other hospitals.
“They took us to Birmingham Heartlands, where the system had been a great success. They had the same type of estate as us, spread over a wide area. They were brilliant, very accommodating. They went through all the problems they had previously and explained how successful the ProEconomy system was at eradicating Legionella. That made me think we needed to trial the system to see if it could work for us.”
Claire says: “We started with an installation at the head and neck ward at the Churchill Hospital, where we had the showers out of use and where calorifiers giving us temperature control issues. Depending on how the system worked, it would be a showcase of what we could introduce to the bigger site at John Radcliffe.
“The result was amazing. In the pre-sample, before the ProEconomy system went in, we had nine positives out of 16 sites sampled. In the first month sampling, after the installation, we were down to just one positive. That one positive stayed for a while. The system allowed us to see that and we evidenced that the outlet concerned was used very infrequently.
“Phil Mitchell, the environmental estates manager, met with the users in the department. They felt the outlet was essential to them so they now flush it regularly and we are now OK.
“The head and neck ward at the Churchill has now been clear for over three and-a-half years.”
Success is the basis for business case
Clare explains: “The success at the Churchill gave us the basis to produce a business case to the trust board to install the copper and silver system into John Radcliffe to help eradicate the Legionella issues we were facing here.
“The first system went into the JR1, Women’s Centre. It’s a large, eight-storey block. We and ProEconomy knew it would an ongoing process to eradicate Legionella and balance out the copper and silver to get the right flow across the complex water system.
“The ProEconomy system has now been in for two years. Through the sampling and the low levels of copper and silver identified in certain areas, we could establish which little used outlets weren’t being flushed. This allowed us to report to the hospital infection control committee on the areas which were not being flushed. The infection control team is very supportive and has worked with us to get the areas to undertake their flushing. They went to the departments and highlighted the risk to them of not flushing.
“As soon as we have a positive sample the outlet is taken out of use and put on a daily flushing regime, which we do in-house. It goes into back into use after three consecutive, clear results.
“Now, for last two months we’ve been clear, with no positives in the Women’s Centre.”
Claire says: “The trust undertake mobile renal dialysis at the bedside in the Women’s Centre. Andy Mossman, the technician for renal, was concerned about the levels of copper and silver, which can be an issue with renal. We had a meeting with ProEconomy which showed that, as long as Andy has a portable RO as part of the machine network, it will remove the ions, allowing the water to be used for renal dialysis.
“They were already using a mobile RO in the Women’s Centre but have intensified its use. We also share the work books with Andy so he can see the current levels in the hospital site.”
Claire explains: “We have regular meetings with ProEconomy’s Byron and Birgitta Bedford and with Richard and Sonia King. Tony Gray, ProEconomy’s service technician, undertakes all the water sampling across the sites. The sample locations are rotated monthly at each building.
“ProEconomy sample for copper and silver and advise us if there are any positives in the samples. We do our own sampling for Legionella and monitor our positives if there are any.
“The installation at JR2, the main hospital, went in in September 2016. In the NICU (neonatal intensive care unit) we kept finding positives even though the unit was doing well. On investigation, we found the NICU had its own water supply. So, we installed a further, small copper and silver ionisation system just to support that department.”
All clear for the past three months
A delighted Claire says: “For the past three months we’ve had ‘all clear’ on JR1. It’s working through. With infection control’s help, we are ensuring we get the educational message over about the need for flushing. Having infection control supporting us is fantastic. Lisa Butcher is the lead for infection control, her support has been tremendous.
“ProEconomy’s copper and silver ionisation system has been a very easy install – even achievable at JR2 with its large diameter mains pipework. We did not have to isolate any of the services. The install was done overnight. It’s straightforward.
“What struck me was how quickly it starts to have an impact, even with the historic, complex systems we have. You’d never design a system like that these days.
“The only negative is, we had some blue toilets – the old porcelain style ones, with a ‘cracked’ finish. Bleach would clean it but we can’t use that. So, we replaced the old sanitary ware, which needed doing anyway. The new toilets are fine, with no colouring.
“In all honesty, a few blue toilets were the least of my worries, considering that we’ve got rid of Legionella and reduced the positives.”
Claire says: “For JR2, the main hospital, we started with low silver and copper levels and built up to try to alleviate any issues with silver. We’ve had none so far. ProEconomy are looking at products which are bio-friendly and could overcome similar issues. It will be helpful if products like that could be used in hospitals.
“Three of the systems have clear results each month. It’s just JR2 where we need to slightly increase the silver and get the full flushing system in place with the co-operation of staff.
“I’d certainly recommend the ProEconomy system to other hospitals. We have different size systems, which show the range the system can work to.”
Claire explains: “We have our own water hygiene team, established around three years ago. It reduced our contractor’s costs phenomenally. It means we have control over the work done and it gives us huge benefits. We control and manage our own water system on the ZetaSafe recording system. Our PPM tells us where to do the testing. We scan the individual barcode for each outlet, each asset, and keep an audit trail of the maintenance of that asset. We can check historic temperatures and sample results, TMV replacements, servicing, etc.
“Phil Mitchell, who heads-up the water hygiene team, is looking at taking on board Tetras, ProEconomy’s cloud based water management system, to support him.”
No patient was affected
Claire adds: “Throughout the time, even when we had positives, no patient was ever affected and all outlets were managed to ensure any risk was eradicated. No matter what we did, replacing showers, etc, we couldn’t get rid of it.
“Now the water sample results have gone from a ‘Red’ sheet to a nice ‘Green’ sheet. That’s all thanks to ProEconomy’s copper and silver ionisation system. It works fantastically.
“It’s the first time, after 20-years in estates, I’ve come across a system that’s so effective in managing your water system. It’s a blessing.”