Boards are required to ensure that effective governance is in place to deliver a building that is safe for its intended population, starting at the point of project inception. A project duty holder should be appointed for each project, with clear targets set and the expected outcome that the building poses no risk of harm to patients in regard to waterborne hazards. A Project Water Safety Group (PWSG) should be formally appointed and empowered to ensure the project delivers a safe building for patients.

The PWSG should develop a project-specific water safety plan (PWSP), identifying all sources of exposure to water and wastewater that could pose a risk. Each stage of the process, from concept to handover and beyond, should be risk-assessed by considering the susceptibility of patient groups. The design of water systems must minimize the risk of microbiological contamination. This includes ensuring that no materials, components, or fittings used in the water system present a risk of microbial contamination, i.e., avoiding wet testing and ensuring each item is unused, individually packed, and certified.

All involved in the project must receive appropriate training to understand the factors that can cause harm from water, wastewater systems, and associated equipment and how to prevent them. Ensuring relevant experience and competence, rather than relying solely on job titles, is the key to success. Detailed consideration and expertise are needed to ensure all system hazards and associated risks have been identified and mitigated in the water system’s design, construction, installation, and operation. Crucial installation related to water systems should only be carried out by those specifically trained to work on healthcare water systems and follow processes approved by the PWSG. This ensures that all individuals understand the risks to patient safety from their actions.

Procurement practices must consider the need to ensure that water safety is a critical element of the new build process and does not introduce risks to patient safety throughout the lifecycle of the building. To prevent contamination of water, wastewater systems, and associated equipment before handover, site welfare facilities must be provided for all contractors. The tender specification must clearly define the water system acceptance criteria, which should be agreed upon by the PWSG. The tender specification should include the sampling and monitoring plans, and the data required to determine that all systems are safe.

The filling and commissioning plan must follow the PWSP and reflect that all systems should only be filled and operated with disinfected water through the point of entry filtration system.
Commissioning must occur at the latest possible time before handover after all other building elements have been commissioned. This plan needs a high level of focus and effort to prevent contamination of the water and wastewater systems as set out at project inception and agreed upon by the PWSG. For acceptance at handover, all commissioning records should be made available, and these records should form part of the BIM as a fitted model handed to the operations team.