Valve Sizing Tool

Cost Benefit

Monklands Hospital, NHS Lanarkshire

A rolling replacement with Horne Optitherm of ageing taps across the Monklands Hospital estate, which previously included a number of different styles and brands, has led to significant improvements for the FM team, Control of Infection, housekeeping and fewer interruptions for staff involved in direct patient care. 

We've only had one tap that required repair. It was replaced and then removed to the workshop. There was no 'downtime' at the handwash faciility and no closing of ward areas, meaning no disruption. I love this tap because I can fit it and forget it; it's one less headache for me BIlly Lindsay, Maintenance Manager

The Numbers

  • 18
    Time frame
  • 175
    Units installed
    to February 2012
  • 1
    # Repairs
  • 37.5
    Time saved
    hours per annum
In 18 months, and with 175 [Optitherm] taps so far installed, we've only had one tap that required repair. That tap was replaced and then removed to the workshop - resulting in no downtime at the handwash facility concerned and no closing of ward areas, meaning no disruption. I love this tap because I can fit it and forget it; it's one less headache for me BIlly Lindsay, Maintenance Manager

Maintenance Headache!

Monklands Hospital is a large district general hospital in Airdrie, North Lanarkshire, offering acute services plus a 24-hour accident and emergency department. It has 535 in-patient beds.

Monklands is an ageing building; some departments opened in 1974 with the remainder fully open by 1977. Various upgrades and refurbishments over the years, and a very informal to non-existent policy on handwash station configuration, meant that a great number of different tap brands, and designs, had been installed across the hospital estate, mostly with the thermostatic mixing valve relatively inaccessible behind the wall-panelling.

Broken levers, under-performing and inaccessible TMVs, and taps with recently outlawed swan-necked spouts (having been identified as a potential reservoir of infection from pathogens) were problems that began to mount up and become an increasing battle for the maintenance team to attend to.

Sampling of the water supplies upstream of the TMV, now required as a means to identify if the water supplies are colonised with harmful pathogens, was also an increasingly time-consuming process, involving the removal of wall panelling, and exposing the services void to the ward environment. There are infection risk implications for patients in the immediate vicinity of this wall breach and, therefore, measures to avoid their exposure to harmful bacteria, viruses and fungi from within the wall cavity must be taken. These measures are both time-consuming, potentially disruptive (to the delivery of healthcare) and costly.

Although the maintenance team were well aware of the growing problem, an audit by the Healthcare Environment Inspectorate (HEI) in November 2009 drew closer attention to non-compliance with guidelines presented in HTM 64 Sanitary Assemblies (Now HBN 00-10) and SHFN 30 Infection Control in the Built Environment. The HEI also recorded complaints from healthcare staff of increasing delays between maintenance issues being reported and them being attended to, which demonstrated the scale of the problem. Another issue raised by the HEI team was a lack of evidence to suggest that Infection Prevention and Control were considered part of the procurement process for new equipment.

Monklands Hospital Board accepted the recommendations, having been aware of the need to more thoroughly address the problem - it was considering a long term ward refurbishment problem, starting with Ward 22, which had been earmarked for upgrade in December 2009. This presented an opportunity to research, define and trial a new handwashing arrangement, which, if successful, would become standard across the hospital estate.

Design Committee

As per the recommendations of the HEI and the Infection Control in the Built Environment document, a committee comprising estates personnel (hard FM), Infection Prevention and Control (IPC) and hotel services staff (soft FM) was established to evaluate various components that would form a standard clinical hand-washing module: IPS frame work and wall paneling, basin and trap, tap and associated thermostatic control, soap, gel and hand-towel dispensers.

The evaluation committee discussed, at length, problems encountered in the past as well as recommendations by the newer published guidelines;

  • Stenotrophomonas Maltophilia had previously been isolated from swan neck taps at Monklands, and so the team were keen to avoid them for their new installations. Newer guidelines also recommended against this design feature - for the very same reasons (partial drain down of the spout on flow closure,  whereby water is exchanged for non-sterile air from the ward environment, and the residual column of tepid water in the upstanding part of the spout creates ideal conditions for bacteria proliferation).
  • The team were also keen to avoid behind-the-wall TMVs feeding manual lever taps; this presented difficulties with accessibility to the TMV\, both for its maintenance and for sampling the upstream water supplies. Again, this departure in their thinking tied in well with new regulations for the control of Legionella in healthcare: HTM 04-01 now recommends that the mixed water deadleg should be minimised, TMVs should be connected directly to the outlet, or be integral with it, and should be the method of flow and temperature control. In other words, the regulations were describing a thermostatic tap.

Tap Selection

Trial, Approval, Standardisation

Ward 22, Acute Elderly Medicine and Rehabilitation, was refurbished in December 2009 and 25 new clinical handwash modules were installed. 

A review of the installation highlighted the following favourable outcomes:

  • No complaints had been received about the tap's flow rate, in fact, nursing staff had reported that the 6 Litres/minute flow rate was entirely adequate for clinical hand-washing activities.
  • Nursing staff had commented that the temperature was comfortable and consistent even when there were problems with hot water temperatures elsewhere in the system. In addition, the tap performance with respect to temperature control was significantly better than the previous installations, especially in comparison to sensor-operated outlets.
  • Its ease of maintenance was a transformation and, especially, accessibility for routine water sample collection had rendered a previous 30 minute job to one that could be completed in under 2 minutes.

The success of the Ward 22 refurbishment prompted the decision to standardise on the Optitherm for clinical handwash both at Monklands and throughout the rest of the NHS Lanarkshire Trust estate.  Since then, 175 Optitherm have been installed in Monklands' Acute Elderly, Haematology, Dermatology, Renal/Endoscopy wards and also the ITU, with a further 50 planned for the Outpatients department.

In 18 months, only 1 out of the 175 taps installed actually required to be removed to the workshop for maintenance - a quick swap over with a new tap body meant the wash station was never out of commission and there was no interruption to the delivery of healthcare.

This reduction in maintenance time is significant. Billy Lindsay calculates it will equate to an annual time-saving of approximately 37.5 hours. Additional savings will also be accrued in the expected use of fewer spare parts and replacements, and by not needing to breach any wall paneling for maintenance or water sampling.

Horne 15 TMV supplying blended water to lever taps. Thermal disinfection facility via upstream ILTDU, In-line Thermal Disinfection Unit

Case Study: Sustainable Water Hygiene