Valve Sizing Tool

Our new ILTDU Champion!

James Donagain

Meet James Donagain, a seasoned professional in facilities compliance and water hygiene, and current Head of Healthcare Compliance at Skanska UK. James's journey with the Horne ILTDU began as he joined Zeta Compliance Services, bringing his expertise to advising a a number of NHS healthcare facilities including Kings College Hospital (KCH) in London and a large NHS Trust in the Midlands. Before joining Zeta, James served as a Hard FM Manager at a Cambridgeshire NHS Trust and it was during this tenure that he initially encountered Horne's patented ILTDU thermal disinfection technology. His curiosity was thoroughly piqued when he attended their CPD seminar titled "Engineering vs Pseudomonas, Legionella and the Retrograde Contamination of Domestic Water Systems by micro-organisms." Intrigued by the potential of the ILTDU, In-Line Thermal Disinfection Unit, James eagerly sought an opportunity to witness its efficacy first hand.

At KCH, and later at the Midlands NHS Trust, persistent Pseudomonas Aeruginosa (PA) contamination posed a significant challenge.  Their traditional remedy with chemical treatment proved mostly ineffective and highly inconsistent, leading to prolonged down-time of water outlets, increased consumable and hardware costs, and mounting water analysis cost - all the while patient safety was being continuously eroded. 

Read on to appreciate the significant savings James unveiled by simply swapping chemical for thermal disinfection at PA positive water outlets.

Numbers to Note

  • 92%
    volume reduction
  • 75%
    cost reduction
  • 70%
    Time saved
    per outlet
  • 60%
    Water Sampling
    cost reduction
[the ILTDU] is so easily used, over and over again, and without significant downtime or disruption – it’s uniquely effective and therefore so much more sustainable. Plus, we don’t need to pump our [water] systems full of chemicals that have been shipped half way around the world James Donagain

A thorough examination

James commenced his evaluation with the meticulous analysis of water sample data at both Kings College Hospital (KCH) and then again at the large NHS Trust. To establish a baseline position, his methodology involved gathering comprehensive information on historic and current water sample test data, operational costs and downtime of outlets. During a 6-month trial at Kings College Hospital (KCH), regular water sample data was collected from outlets protected by Horne's ILTDU technology, where outlets received routine thermal disinfection. This data was then compared with an equivalent control group of unprotected outlets that underwent their standard chemical disinfection. Comparison of both data sets showed significant reductions in PA counts in the ILTDU group and gave firm validation for its effectiveness in resetting PA to zero.

Similar findings were replicated at the large NHS Trust in the midlands, indeed the trial there zeroed in on one outlet that had endured ongoing contamination (>8 months) despite undergoing six rounds of chemical treatments and being slated for last-resort hardware replacement. This outlet represented a critical test case for evaluating the efficacy of ILTDU technology in addressing entrenched water hygiene issues.

James' trial meticulously documented each step, from the initial sanitization of tools and components to the execution of the thermal disinfection protocol. Witnessing the initial thermal disinfection of the condemned shower, James was astounded to see the discharge of 'golden-coloured water', interpreting it as the biofilm within the pipework being 'cooked off'. Subsequent analysis revealed the remarkable outcome: a single thermal disinfection treatment via the ILTDU had successfully eradicated a stubborn PA contamination, providing a compelling validation of its efficacy and underscoring its potential as a game-changing solution for water hygiene management.

The attached document "Sustainable Pathogen Control" offers a thorough and fully detailed account of James' assessment and the tangible cost savings achieved.

Procedure Pivot

James' findings from the comparative and test-case evaluations provided him with compelling evidence of the superiority of ILTDU-covered outlets in managing PA contamination. The technology actually works.

At Kings College Hospital, these outcomes served as a catalyst for a policy change for all future refurbishments; to install the ILTDU, as a stand-alone unit feeding taps and mixing valves, or within Horne T4 and T9 type shower panel models.

Following the reinstatement into service of the previously condemned trial shower, James advocated for and implemented a revision of the Midlands Trust's HTM 04-01 Standard Operating Procedure (SOP).  This was adopted across all 3 hospitals in March 2021 and simply swapped out chemical disinfection for ILTDU installation and thermal disinfection. To further enhance the new protocol he also engaged nursing, clinical, cleaning and FM staff to work together - how could they, additionally, improve the health of the water system? This collaborative approach has greatly strengthened infection control practices, highlighted training needs whilst promoting a culture of shared responsibility for enhancing patient safety.

Stacking the Savings

Prevention is Better...

To further mitigate PA contamination and ensure patient safety, James has also proposed implementing a regular Planned Preventative Maintenance (PPM) regime. This involves conducting quarterly thermal disinfection alongside required six-monthly water sample tests. Additionally, for outlets such as showers that tend to require quarterly descaling, incorporating thermal disinfection into the maintenance schedule minimises additional workload while enhancing water hygiene management. Under this regime, samples increasingly come back clear for PA. For the few that don't, the reset is simple. 

Through James Donagain's leadership and influence, more and more healthcare facilities are embracing the ILTDU for local thermal disinfection as a proactive and cost-effective approach to water hygiene management. 

In a nutshell, the ILTDU is a simple means to improved patient safety, demonstrable operational efficiencies and responsible environmental stewardship.

Horne ILTDU, In-line Disinfection Unit, in D-Mode, Disinfecting downstream pipework, tap, shower or thermostatic mixing valve

Case Study: Eureka Moment from ILTDU