Anmerkung: Intro -- Safe Water in Healthcare: A Practical and Clinical Guide -- Copyright -- Dedication -- Contents -- Preface -- Acknowledgment -- 1 Importance of leadership and governance -- Overview -- Leadership -- Governance -- In summary -- References -- 2 Design, construction, and commissioning of healthcare water systems -- Introduction to designing safe water systems -- Project water safety plan -- Project governance and accountability -- Project WSG skills and competencies -- Consultation -- Supply water -- Patient risk factors -- Drains -- Supported learning -- Commissioning -- Commissioning plans -- System filling -- Case study: Failures in filling the water system -- Case study: Failures due to partial occupation of a hospital build program -- Handover -- Partial handover -- Examples of checks for commissioning and handover within the project WSP -- References -- 3 Overview and introduction to safe water in healthcare -- Background -- How do bacteria get into buildings' water systems? -- Water supply to healthcare buildings -- Mains water supply -- Case study: Microbial contamination of water supply -- Private water supplies -- Monitoring water supplies -- Maintaining water supply in an emergency -- Bottled water -- Water distribution within healthcare buildings -- Introduction to biofilms -- Case study: Microbial contamination of flexible hoses -- What areas of the water system present microbial risks? -- Learning points -- References -- 4 Cold water systems -- Introduction -- The cold water supply -- Microbial hazards in the supply water -- Water quality within the building -- Why do you need cold water storage? -- Design and construction of cold water storage vessels -- How much cold water should be stored? -- Temperature management of the cold water -- Microbiological risks associated with cold water tanks. , Case study: Cleanliness of storage tanks -- Monitoring of the cold water system -- Case study: Excessive cold water temperatures in new build -- Case study: Filling sections prior to completion -- Maintaining cold water supply in an emergency -- Recommendations for cold water systems -- Learning points -- Risk assessing the cold water system -- Guidance, regulations, and further reading relevant for cold water systems -- References -- 5 Hot water heating systems -- Hot water system -- Temperature requirements for hot water calorifier, flow, and returns? -- Balancing the system -- Case study 1 -- System design and temperature monitoring -- How is hot water produced? -- What is stratification? -- Electrical immersion-type calorifiers -- Combination water heaters -- Microbiological problems with calorifiers and hot water systems? -- Case study 2: What to do when a bolus of potentially contaminated material is injected into your hot water system? -- Transmission routes for calorifiers and hot water systems? -- Monitoring hot water systems -- Recommendation for hot water heaters -- Regulations and guidance for hot water heaters -- Risk assessing the hot water system -- References -- 6 Systemic contamination -- Identifying systemic contamination? -- How does systemic contamination occur? -- What are the impacts of systemic contamination? -- Case study involving Legionella -- Case study involving Cupriavidus pauculus -- Case study involving Pseudomonas aeruginosa -- Monitoring systemic contamination -- Recommendation for systemic contamination -- Issues to consider when risk assessing systemic contamination? -- Guidance for systemic contamination -- References -- 7 Peripheral components -- Introduction -- Why are peripheral components colonized? -- Case study: Outbreak associated with peripheral components that were contaminated with P. aeruginosa. , Strainers to trap harmful debris -- Thermostatic mixer valves -- What is a thermostatic mixer valve and how does it work? -- What are the different types of thermostatic mixer valves? -- Why are TMVs used? -- What are the risks of scalding? -- Where should you not install TMVs? -- How should TMVs be maintained? -- What are the regulations concerning TMVs? -- Microbial problems associated with TMVs -- Solenoids -- What is a solenoid and how does it work? -- Why and where are solenoids used? -- How should solenoids be maintained? -- What are the regulations in the use of solenoids? -- What microbial problems are associated with solenoids? -- Flexible hoses -- What is a flexible hose? -- What are flexible hoses used for? -- What are the microbiological problems with flexible hoses? -- Outbreaks associated with flexible hoses -- What are the alternatives to EPDM? -- What are the regulations concerning flexible hoses? -- What other types of peripheral components are used? -- External influences on the safe use of water in a wash hand station -- Manual separate hot and cold taps -- Manual operated single-lever taps -- Pedestal taps -- Swan neck taps -- Thermostatic mixer tap -- Elbow levers -- Knee or foot-operated water outlets -- Sensor-operated tap -- Different type of outlets fittings -- Aerators -- Flow straighteners -- Recommendations for peripheral components -- Risk assessment considerations for peripheral components -- Regulations for outlet fittings -- References -- 8 Wash hand stations -- How do wash hand stations become contaminated? -- What are the transmission routes and microbial risks? -- Activity space -- Splashing and dispersal from wash hand basins -- What does a safer wash hand station look like? -- Patient wash hand station -- Recommendation for wash hand stations -- Assessing the risks associated with wash hand basins. , Regulations for wash hand stations -- References -- 9 Sinks in ward kitchens or domestic areas -- What is a sink and what is it used for? -- What are the microbial contamination sources of stainless steel sinks? -- What are the transmission routes? -- Outbreaks associated with stainless steel utility sinks -- A hospital-wide CPE outbreak -- Outbreak 1 -- Outbreak 2 -- Guidance on sinks -- Recommendation on sinks -- Risk assessments for sinks -- Questions on sinks -- References -- 10 Showers -- Showers and accessories -- What are the microbiological risks with showers, hoses, and showerheads? -- Shower controller unit -- Shower hoses -- Shower heads -- Ancillary equipment in showers -- Deluge showers -- Shower trolleys -- Patient risk and risk to patients -- Microbial outbreaks associated with showers rooms -- Microbiological monitoring -- Requirements and recommendations for showers -- Risk assessing showers and their equipment -- Guidance -- References -- 11 Assisted baths -- Assisted baths for patient care -- Microbiological problems associated with assisted baths -- Bath accessories and bath toys -- Monitoring of assisted baths -- Recommendations for assisted baths -- Risk assessing assisted baths -- Guidance for assisted baths -- References -- 12 Birthing pools -- Birthing pools -- What are microbiological risks from using birthing pools? -- How do birthing pools become contaminated? -- Case study 1: Black particle appeared in the birthing pool water -- Case study 2: Birthing pool drain may have resulted in an outbreak -- Case study 3: Inflatable pools used in healthcare facilities -- Microbiological case reports associated with birthing pools -- Regulations and recommendations for consideration for birthing pools -- Risk assessment criteria for birthing pools -- Guidance and regulations relevant for birthing pools -- References. , 13 Hydrotherapy pools -- What are hydrotherapy/aquatic physiotherapy pools? -- What is aquatic physiotherapy? -- Design -- Commissioning -- Governance -- General -- Hydrotherapy pools -- Bather loads -- How does a hydrotherapy pool function? -- Backwashing -- Day-to-day management -- An overview of the hazards applicable to hydrotherapy pools -- Patient screening -- Fecal pathogens -- Nonfecal pathogens -- Main challenges for hydrotherapy pools -- Emergency action plans -- Outbreak 1 -- Hydrotherapy tanks/tubs/pools used for burns, etc. -- Outbreak 2 -- Whirlpool baths and assisted baths -- Factors to consider in a risk assessment -- Spas, hot tubs, footbaths, etc. -- Outbreak 3 -- Microbiological monitoring of hydrotherapy pools -- Criteria for risk assessing birthing pools -- Guidance and regulations relevant for birthing pools -- Terminology -- References -- 14 Sources of patient drinking water -- Sources of drinking water -- Chilled drinking water dispensers -- Outbreak scenarios -- Outbreak scenario 1 -- Outbreak scenario 2 -- Monitoring of drinking water sources -- Guidance for chilled drinking water fountains -- Requirements and recommendations for chilled drinking water fountains -- Bottled drinking water dispensers -- Recommendations for bottled water dispensers -- Risk assessing water coolers and other drinking sources for patients -- Guidelines for bottled water dispensers -- References -- 15 Drink vending machines -- Drink vending machines -- Microbiological issues associated with drink vending machines -- Monitoring of vending machines -- Recommendations for vending machines -- Risk assessing vending machines -- Regulations for vending machines -- References -- 16 Expansion vessels -- What are expansion vessels? -- Microbiological sources and problems associated with expansion vessels?. , Microbial contamination of expansion vessels and seeding the system?.