Latest reports help dampen the concerns over TMVs

The ongoing threat to health by infection from dangerous micro-organisms was tragically brought to the fore with the infant deaths in Northern Ireland neonatal units in December 2011 and January 2012. These tragic deaths occurred in high dependency units where patients are already typically very poorly and extremely vulnerable. With all such infant fatalities a detailed investigation into the cause is immediately initiated and all parties involved hope that the findings will lead to appropriate preventative measures being introduced to combat any potential reoccurrence.

When this type of incident occurs in the healthcare sector, a lot of attention is focussed on components within the hot water storage and distribution systems, and much of this is directed towards taps and valves. It is human nature to want to isolate a single cause that can be simply removed, but sadly the problem with infection outbreak is that it is very complex and invariably needs to be addressed at a system-wide level.

Terry Rowbury, Director for the Thermostatic Mixing Valve Manufacturers’Association (TMVA) comments: “As representatives of the tap and valve manufacturers, we are used to dealing with these concerns and we find that simply presenting the facts will normally allay people’s fears.

“Based on this experience, the TMVA welcomes the two recent publications which relate to the tragic incidents in Northern Ireland. The first is the Department of Health ‘Advice for augmented care units’, which emphasises the need for adherence to existing guidelines and particularly the need for good hand hygiene and cleaning regimes.

The second is the interim report from the ‘Independent Review of Incidents ofPseudomonas aeruginosa Infection in Neonatal Units in Northern Ireland’, produced by the Regulation and Quality Improvement Authority (RQIA - web link 2 below). The report’s conclusion again emphasised the need for excellent and consistent hand hygiene regimes, as well as ensuring the correct use of washbasins for non-clinical washing.”

The biggest area of consistency between these publications was the reference to the need to adhere to existing guidelines. These have been developed over time and, when adhered to correctly, provide an effective barrier to the proliferation and spread of harmful microorganisms. The HTM04-01 guidelines (Hospital Technical Memorandum 04-01 – The control of Legionella, hygiene, “safe” hot water, cold water and drinking water systems) have been developed with industry and established over time.

The use of correct hot water storage, distribution and end-use temperatures alongside correct installation and maintenance procedures have provided an effective method of combating the threat of infection and rigorous implementation of these guidelines should be the starting point for all healthcare installations.

Terry Rowbury continues: “The TMVA is continuing to work closely with the Department of Health to look at ways of further strengthening existing guidelines. There is also a wider industry desire to engage in a broader research activity with as wide a range of partners as possible. The aim will be to focus on gaps in existing research, which will help to strengthen the collective effort in understanding the root cause of infection outbreak, and how best to design-out any issues on a system basis. On-site decisions are being made with too little understanding of the construction and operation of the products, as well as a use of poor terminology when discussing these fittings.

“For too long now, refurbishment decisions on existing hot water systems in healthcare establishments have been based on anecdotal evidence and ‘bad science’. The TMVA has gone some way towards addressing this by expanding its ‘Frequently Asked Questions’ and ‘Myth-busting facts’ sections atwww.tmva.org.uk, and is now developing a comprehensive ‘Glossary of Terms’ to add to this suite of useful information.

“However, there is still more work to be done, so the TMVA is looking to work with the Department of Health and other industry partners to implement relevant research work to help fill in the gaps. This will provide real data and robust evidence to further expand the information base and provide future comprehensive guidance to the health sector.”