Hot and cold water systems

There are various systems available to supply hot and cold water services that range in size, scale and complexity.
All can present foreseeable risk of exposure to legionella. Temperature control is the traditional strategy for
reducing the risk of legionella in hot and cold water systems. Cold water systems should be maintained, where
possible, at a temperature below 20C. Hot water should be stored at least at 60C and distributed so that it
reaches a temperature of 50C (55C in healthcare premises) within one minute at the outlets.

Before assessing the risks associated with these systems, you need to understand the type of system, its
constituent parts and operation. Simplified examples of different basic systems are:

E1.4 Hot Water: An adequate supply of clean hot water shall be reticulated to all patient treatment, staff
work and patient and staff ablution facilities, as detailed in the Statement of Function (A3).

Provision shall be made to limit the supply temperature of hot water to all patient use fittings to eliminate the
risk of scalding. Maximum temperature at outlets shall not exceed 46C for adult patients except that where
warm water circuits are used, control of circuit temperature to 50C maximum is acceptable. For nursery areas
the maximum temperature at the outlet shall not exceed 42C.

Where patients are expected to have difficulty in adequately adjusting a comfortable showering or bathing
temperature, local thermostatic control is recommended. Such controls are to be installed at high level to
eliminate the chance of accidental resetting of the water temperature.

E1.4.1 Legionella and Microbial Control Hot Water Systems shall satisfy the requirements of AS 3666. Systems
shall be designed to minimise excessive dead legs and enable the quick and easy maintenance of the system for
Legionella and microbial control. Systems serving areas where there are patients with immunodeficiency shall
be regularly tested for Legionella concentration and concentration levels maintained below levels set by the
Health Services risk containment policy.

Health Services shall have in place a regular program of maintenance to prevent Legionella and other microbial
growth in the potable water supply.

Operation of the system at a temperature above 70C for one hour each month and through each outlet for a
minimum of five (5) minutes is one method of protecting warm water systems from the risk of microbial growth.
In addition to this, aerators, shower roses and other such fittings should also be cleaned and sanitised at regular
intervals. This is provided the associated hospital operational and sanitising requirements are complied with.
Dual temperature thermostats are suggested for this purpose. Suitable warning signs shall be displayed at all
impacted outlets during this temperature raising process.

Proprietary systems such as that provided by Edwards Hot Water could be considered. Alternatively, warm water
systems may incorporate an approved chemical disinfection system. A proprietary system such as Rheem Warm
Water and Treatment System could be considered.

E1.4.2 Hot Water Service: Food Handling Areas Domestic hot water provision for the washing of crockery,
glassware and cutlery shall be as described in the Food and Hygiene Regulations.

The requirements are summarised as follows:

1) Rinse water shall be at a temperature of not less than 50C and contain not less than 50 mg/kg of
sodium hypochlorite; or
2) Rinse water temperature shall not be less than 75C.
Where hot water is reticulated at low temperature (below 55C), as in warm water circuits discussed
above, provision shall be made for suitable sanitising of the system and circuit pipework to prevent the
growth of Legionella Bacterium. Aerators, shower roses and other such fittings shall be cleaned and
sanitised at regular intervals.