Too much ado about data: continuous remote monitoring of water temperatures, circulation and throughput can assist in the reduction of hospital-associated waterborne infections

Abstract

National and international guidance provides advice on maintenance and management of water systems in healthcare buildings; however, healthcare-associated waterborne infections (HAWIs) are increasing. To identify parameters critical to water quality in healthcare buildings and to assess whether remote sensor monitoring can deliver safe water systems, thus reducing HAWIs. A narrative review was performed using the following search terms: (1) consistent water temperature AND waterborne pathogen control OR nosocomial infection; (2) water throughput AND waterborne pathogen control OR nosocomial infection; (3) remote monitoring of in-premises water systems AND continuous surveillance for temperature OR throughput OR flow OR use. Databases employed were PubMed, CDSR (Clinical Study Data Request) and DARE (Database of Abstracts of Reviews of Effects) from January 2013 to March 2024. Single ensuite-patient rooms, expansion of handwash basins, widespread glove use, alcohol gel and wipes have increased water system stagnancy resulting in amplification of waterborne pathogens and transmission risk of legionella, pseudomonas, and non-tuberculous mycobacteria. Manual monitoring does not represent temperatures across large complex water systems. This review deems that multiple-point continuous remote sensor monitoring is effective at identifying redundant and low use outlets, hydraulic imbalance and inconsistent temperature delivery across in-premises water systems. As remote monitoring becomes more common there will be greater recognition of failures in temperature control, hydraulics, and balancing in water systems, and there remains much to learn as we adopt this developing technology within our hospitals.