Ensuring the safety and efficiency of water systems in healthcare estates is critical to protecting patient health and maintaining a secure environment. Hospitals, GP practices, and care homes, rely on large, complex water systems that must be carefully managed to prevent contamination and reduce risks such as Legionella outbreaks. Alongside its critical role in hospital hygiene, water is also used in fire safety systems in healthcare premises, and particularly in automatic sprinklers, which play a vital role in keeping patients safe. As both water hygiene and fire safety are directly linked to the well-being of vulnerable individuals, effective management of these systems is not simply a matter of compliance, but a vital component of healthcare safety.
One of the most significant threats in healthcare settings is Legionella bacteria, with the bacterium able to thrive in stagnant water, and — in some instances and under certain conditions — to cause Legionnaires’ disease, a severe form of pneumonia that poses an increased risk to immunocompromised individuals. Across the healthcare estate, in environments that are used frequently by vulnerable individuals — including the elderly and immunocompromised, clean, uncontaminated water is non-negotiable, with any lapses in water hygiene potentially having serious consequences.
Legionella, a waterborne bacterium that thrives in stagnant water, particularly at temperatures between 20 and 50°C, is primarily found in man-made water systems such as storage tanks. In hospitals, where water demand fluctuates, these tanks can become a breeding ground for Legionella if they are not properly maintained. Showers, taps, and cooling systems can then disperse the bacteria into the air, posing a risk to staff, patients, and visitors. Those most vulnerable to Legionnaires’ disease include individuals over 45 years’ old, smokers, heavy drinkers, people with chronic respiratory or kidney disease, and those with weakened immune systems.
Older and larger buildings especially susceptible
Unfortunately, older buildings with large, complex water systems are particularly susceptible to the growth of harmful bacteria, as they often have outdated or inefficient water management systems that can result in stagnant water, poor temperature control, and biofilm build-up — ideal conditions for Legionella bacteria to colonise within and spread. In addition, older buildings may have long, convoluted pipe networks or underused water fixtures, both of which increase the risk of water stagnation, making them particularly vulnerable to contamination. Cold water storage tanks that are configured with either a division, or as two separate tanks, are often installed to enable maintenance, chlorination, and cleaning to be carried out while leaving an uninterrupted water supply to the buildings. However, installing cold water tanks in this way can lead to a tank imbalance, stagnation issues, and the formation of biofilm in one side of the tank if, for example, that tank’s valve activates to meet demand and causes backfilling into the other side.
What can go wrong without adequate precautions
One high-profile example of the potential dangers that can arise occurred at Royal United Hospitals Bath NHS Foundation Trust, which was fined £300,000 in 2018 after the Health and Safety Executive (HSE) launched an investigation which found that the Trust had failed to put in place all the necessary precautions to minimise the risk to patients in the annex to the William Budd ward at Bath’s Royal United Hospital from exposure to Legionella. A 68-year-old patient died from Legionnaires’ disease. This sombre case serves as a reminder of the importance of regular maintenance and stringent safety measures.
In the UK, there are strict regulations governing the management of water hygiene in healthcare estates. The Health and Safety at Work Act 1974 and the Water Supply (Water Fittings) Regulations 1999 set out guidelines for preventing water contamination, waste, and misuse. Healthcare estates and facilities teams must also follow the guidelines in the HSE’s L8 Approved Code of Practice (AcoP) and guidance, Legionnaires’ disease. The control of legionella bacteria in water systems, which focus on the control of Legionella bacteria in water systems. Regular risk assessments, maintenance, and monitoring of water systems, are critical to reducing the likelihood of contamination. Failure to comply with these regulations can lead to prosecution, as well as severe consequences, such as waterborne disease outbreaks.
Water efficiency
There are further considerations for those managing healthcare buildings, particularly given the NHS’s current drive towards demanding carbon reduction targets. Water, one of the planet’s most vital resources, is fast becoming a luxury that we can’t afford to waste. As population growth and climate change drive up demand, the UK’s Environment Agency estimates that by 2050, an additional five billion litres of water will be needed each day.1
Historically, water efficiency has not been a top priority for many healthcare estate management teams. However, with increasing awareness of sustainability issues, there is a growing recognition that water conservation is crucial. Reducing unnecessary water usage not only helps alleviate pressure on the environment, but can also lead to significant cost savings for healthcare facilities.
Electronic tank management systems are critical for anyone looking to improve water safety and optimise tank performance. In healthcare settings, where an uninterrupted water supply is essential for critical functions such as patient care, sanitation, and medical procedures, the consequences of a water system failure can be catastrophic. An overflow or water tank failure in a hospital could damage expensive medical equipment, or disrupt activities in sensitive areas such as operating theatres.
Electronic tank management systems and delayed action mechanical float valves help prevent such failures by ensuring that water storage tanks are consistently monitored and maintained. These systems can detect potential issues such as leaks or overflows early, allowing for proactive maintenance, and avoiding major disruptions.
Tanktronic, Keraflo’s electronic tank management system, for example, uses sensors to constantly monitor the water levels, temperature, and volume in cold water tanks. Readings on these are displayed on a control panel, providing an accurate insight into the condition of stored water. Tanktronic’s design is built around automation and intelligence, ensuring that the water in both compartments of the tank is regularly cycled and refreshed. One of the key features of Tanktronic is its ability to activate both valves in multi-compartment tanks simultaneously. This simultaneous filling prevents the water in one side of the tank from sitting unused for too long, which eliminates the risk of stagnation and biofilm formation.
Additionally, Tanktronic can be integrated into Building Management Systems (BMS), allowing for remote monitoring and control. It offers two-stage alarms for both high and low water levels, as well as temperature monitoring, ensuring that healthcare engineering personnel are alerted to any issues before they become serious. If water levels drop below or exceed acceptable thresholds, or if the water temperature rises into a dangerous range, Tanktronic triggers alarms that can be sent directly to third-party systems or devices. This helps prevent any major disruptions caused by water system malfunctions.
Automated water level adjustments
Tanktronic also includes a calendar function, which allows users to automate water level adjustments based on the specific needs of their facility. For example, the system can lower the water level during periods of low occupancy, and raise it again during peak demand times. This capability ensures that water is turned over regularly, both preventing stagnation and optimising water usage.
Keraflo’s Servo Ceramic Valves (SCV), which can be integrated with the Tanktronic system, are particularly effective in this regard. These valves work seamlessly with Tanktronic’s sensors, responding automatically to changes in water demand. They can activate both tank compartments at the same time, ensuring that water is consistently turned over in both sides of the tank, while still allowing independent operation when maintenance is required.
One of the additional benefits of installing Tanktronic is its ability to streamline maintenance. The system provides detailed, accurate information on the condition of the water in storage tanks, meaning that maintenance teams no longer need rely solely on routine inspections to check for issues. Instead, they can perform targeted maintenance when the system alerts them to a potential problem, such as a rise in temperature.
This data-driven approach to water management not only reduces the time and effort spent on unnecessary maintenance, but also helps to minimise the use of chemicals required for tank cleaning and disinfection. By preventing biofilms from forming, facilities can reduce the frequency of chlorination treatments, saving both time and resources. Electronic tank management systems like Tanktronic also help facilities maintain compliance with water safety regulations by providing accurate, up-to-date records of water usage, temperature, and hygiene levels.
Float valves
While electronic tank management systems offer electronic control and monitoring, delayed action mechanical float valves play a crucial role in ensuring that water levels are maintained efficiently. Keraflo’s Aylesbury range of mechanical valves are designed to provide an accurate and efficient method of controlling the level of stored water in tanks with or without raised valve chambers. These mechanical float valves prevent the constant trickling of water into the tank, which can lead to stagnation and uneven water levels. Instead, they only activate when the water level in the tank drops to a specified point, triggering a quick, full refill, rather than a slow, continuous one. This means the water enters the tank at a maximum flow, actively churning the water in the tank, and avoiding the slow, continuous refilling that can create stagnant zones where bacteria may grow.
The Aylesbury range is ideal for pumped systems because the open to close ‘on/off’ valve operation avoids pump hunting and water hammer. The K Type and KAX Type valves’ weighted float can be adjusted to a number of positions on the brass float arm, allowing the tank’s stored water level to be easily modified. While identical in operation to the K Type, the KAX Type valves have extended drops, and are suitable for tanks with raised valve chambers. The KB Type valve has a number of benefits — including a virtually unlimited range of opening and closing levels, and easy adjustment of variables (capacity can be matched to demand). Keraflo’s Tanktronic and Aylesbury range of valves have been used in a variety of buildings, including the Garrett Anderson Centre at Ipswich General Hospital, Queen’s Hospital, Burton on Trent, and by the Ministry of Defence.
Fire sprinkler valves
The use of automatic fire sprinklers is strongly recommended by all UK fire and rescue services, especially in hospitals, where fires can put vulnerable individuals at greater risk. In 2022-2023, NHS Trusts recorded 1,372 fires, marking an 18% increase on the previous year.2 This equates to about four fires per day across the NHS estate, highlighting the critical need for effective fire suppression systems. Sprinklers are particularly valuable in healthcare settings, as they react to heat by spraying water when temperatures reach 60-70 °C, helping to suppress fires, and giving those with mobility issues more time to evacuate.
Keraflo’s Fire Valves, the first of their kind to receive accreditation from the Loss Prevention Certification Board (LPCB) under the stringent LPS 2083 standard, provide an excellent solution for fire sprinkler systems. Our FP 1276 Flow Type Fire Sprinkler Tank Float Valve Kit is ideal for both deep and shallow tanks, offering adjustable water level settings to meet the unique demands of sprinkler systems. The FB Type float valve operates quietly, eliminating common issues like water hammer and valve bounce. With accessible, externally mounted control valves, maintenance is simplified, and servicing can be carried out without needing to re-chlorinate the tank. These features, combined with their high reliability and a 10-year warranty, make Keraflo’s fire sprinkler valves a trusted choice for healthcare facilities.
Managing cold water storage
The management of cold water storage in healthcare estates requires a delicate balance between ensuring water hygiene and optimising efficiency. With older buildings posing a significant risk for the growth of harmful bacteria such as Legionella, healthcare estate managers must prioritise the implementation of solutions that prevent contamination and ensure compliance with regulatory standards. Fire safety must also be a top priority in environments where vulnerable individuals may struggle to evacuate quickly.
Electronic tank management systems, delayed action mechanical float valves, and certified fire sprinkler valves, offer healthcare facilities an effective way to manage both water hygiene and fire safety. These technologies not only help prevent the growth of harmful bacteria, but also contribute to water conservation and fire risk reduction by ensuring that tanks are refilled efficiently, and water is always available when needed. Adopting these tools will be key to helping healthcare estates manage their resources safely and sustainably.
Richard Braid
Richard Braid joined Keraflo – part of Davidson Holdings – and ‘a leading UK manufacturer and provider of water and energy saving management solutions for commercial, residential and public sector buildings’ – as managing director in 2021. Spanning the past three decades, his career has firmly been cemented within the heating and hot water sector, working across various sales, marketing, and specification roles. His previous positions include head of Showers and Hot Water at RXG Group, National Development manager at Bristan, Marketing director at Biasi, Marketing manager at Halstead Glen Dimplex, and Commercial Product manager at Twyford Bathrooms.
References
1 Environment Agency. A summary of England’s revised draft regional and water resources management plans [Internet]. England: Environment Agency; March 2021. https://tinyurl.com/4zbd9xmv
2 NHS Digital. Estate Returns Information Collection 2022/23, Summary page and dataset for ERIC 2022/23 (Report V2i, tab 6) [Internet]. England: NHS Digital; December 2023. https://tinyurl.com/5n8sah5p