Healthcare buildings present unique challenges when it comes to water safety management. Complex water systems, vulnerable patient populations, and round-the-clock operations create an environment where legionella and other waterborne pathogens can pose serious risks if not properly controlled.
“Healthcare facilities are particularly challenging environments for water management,” explains Kieran Irving, Legionella and Water Treatment Manager at our company Lucion Services Ltd.” The combination of complex plant rooms, domestic water systems, chlorine dioxide units, reverse osmosis systems, decontamination units, dental unit waterlines (DUWL), extensive pipework, subordinate and tertiary loops, varying usage patterns, and most importantly, immunocompromised patients. This means we need to be exceptionally vigilant in our approach to legionella control. Implementing multiple guidance documents such as Health Technical Memorandum 04-01 (HTM 04-01), Health and Safety Guidance 274 and various British standards also makes it more of an intricate process. “
The HTM 04-01 provides comprehensive guidance specifically for healthcare premises, addressing not only legionella but also other waterborne pathogens such as pseudomonas aeruginosa and stenotrophomonas maltophilia.
Unlike general guidance, HTM 04-01 recognises the heightened risks present in healthcare settings and sets more stringent standards accordingly. The guidance is divided into four key parts covering design and installation, operational management, pseudomonas control in augmented care units, and thermostatic mixing valve specifications.
The Water Safety Group
Central to HTM 04-01 compliance is the establishment of a Water Safety Group (WSG) – a multidisciplinary team responsible for developing and managing the Water Safety Plan (WSP).
“The Water Safety Group approach is crucial in healthcare,” explains Kieran. “It brings together people with different expertise – from estates to facilities, to infection, prevention and control (IPC) without forgetting external advise from Legionella and Water Hygiene experts. Collectively, these individuals come together to from an efficient and robust Water Safety Plan to implement across the Healthcare premisesadvice.”
WSG is responsible for:
- Commissioning and reviewing comprehensive risk assessments
- Developing and maintaining the Water Safety Plan (WSP)
- WSP designed and implemented in accordance with HTM’s & BS 8680:2020 Water Quality. Water Safety Plans. Code of Practice.
- Identifying potential hazards and implementing control measures
- Advising on remedial action when contamination is detected
- Ensuring adequate resources and training are in place
- Stricter Standards for Patient Safety
Healthcare settings require a more rigorous approach to legionella management than standard commercial buildings. Unlike the HSE’s HSG 274 guidance, which sets action levels at 100 colony-forming units per litre (cfu/L), HTM 04-01 Part B requires investigation of any detection of legionella, regardless of concentration.
“In healthcare, we can’t afford to wait until bacterial counts reach typical action levels,” Kieran emphasises. “Even low-level detection requires immediate investigation and, where necessary, resampling. Our vulnerable patient populations simply don’t have the immune resilience of the general public.” Kieran believes any detection should be monitored across the industry to ensure no further bacterial growth
Comprehensive Water Management Services for Healthcare Settings
Our company, Lucion Services Ltd, provides specialist support to healthcare facilities across all aspects of water safety management:
Risk Assessment & Water Safety Plans
Our LCA-certified consultants work with your Water Safety Group to develop comprehensive, HTM 04-01-compliant risk assessments and Water Safety Plans tailored to your facility’s specific needs.
Legionella & Pseudomonas Sampling
We undertake water sampling to the exacting standards required for healthcare environments, with analysis at detection limits below 100cfu/L as specified in HTM 04-01.
Ongoing Monitoring & Inspection
Regular monitoring programmes ensure early detection of potential issues, with temperature checks, outlet flushing verification, and system inspections forming part of a proactive management approach.
Water Systems Cleaning & Disinfection
Where remedial action is required, our teams can undertake cleaning and disinfection of cold water storage tanks, calorifiers, and distribution systems to restore water quality.
Legionella Awareness Training & Support
We provide training for estates teams, Water Safety Group members, and clinical staff to ensure everyone understands their role in maintaining water safety.
Protecting Vulnerable Patients in Healthcare
Recent UKHSA data shows that 4.5% of legionellosis cases in 2024 were linked to healthcare facilities. While this represents a relatively small proportion of overall cases, each one represents a preventable infection in a vulnerable patient population where outcomes can be severe.
Effective water safety management, grounded in HTM 04-01 guidance and delivered through a collaborative Water Safety Group approach, remains the cornerstone of legionella prevention in healthcare settings.
Reflecting on our legionella water services provision and our extensive work with the NHS, Sales Director Rich Murphy said:
“Healthcare water management isn’t just about compliance; it’s fundamentally about patients, staff and visitors.
We work alongside NHS estates teams and infection control specialists, our specialist legionella team provide the technical expertise and practical support they need to maintain safe water systems day in, day out.”
From managing holiday period flushing regimes to responding to urgent sampling requirements, our team provide responsive, practical support that fits within healthcare operational realities.
