This article, titled “Defining water safety in healthcare premises,” proposes fundamental shifts in the understanding and management of water and wastewater systems within healthcare facilities. Authored by M. Weinbren et al., and published in the Journal of Hospital Infection, the paper critically examines the traditional concept of ‘water safety,’ deeming it outdated and insufficient given the evolving risks, particularly those related to antimicrobial resistance (AMR).
The core foundational shift proposed is the explicit recognition of water and wastewater systems as uniquely intertwined. This challenges the conventional view that ‘water safety’ is a standalone concern, highlighting that each system can adversely affect the other, thereby impacting patient safety. Risks are identified as originating at any point from mains water entry to wastewater exiting the site, persisting through every stage of a building’s life cycle.
To address these complex and interconnected risks, the article proposes a new nomenclature and the division of plumbed-in water/wastewater systems into three distinct zones:
- (A) The main body of the water system: This extends from the incoming mains to the last 2 meters of pipework leading to a connected device. The term ‘water safety’ is recommended to specifically refer to this zone.
- (B) The periphery of the water/wastewater system: This critical but often underdeveloped zone includes the last 2 meters of pipework, the connected device (e.g., sink), the drain, the waste trap, and the initial part of the wastewater system’s pipework. The term ‘clinically integrated water/wastewater safety’ is proposed for this area. This zone is recognized as a significant source of risk for transmission of organisms, especially with everyday practices like showering or filling patient water jugs.
- (C) The main body of the in-premise wastewater system: This encompasses the drainage system distal to the initial pipework, extending to the juncture with the municipal wastewater system. The article advocates for the term ‘wastewater safety’ for this zone, emphasizing its often-underestimated role as a “superhighway” for the spread of organisms, including AMR, throughout healthcare facilities.
These foundational shifts are driven by the urgent need to move from a reactive to a proactive approach in managing water and wastewater risks. The paper argues that the current lack of specific terminology hinders the development of necessary expertise, training, guidelines, and research for these critical areas. Furthermore, it stresses the importance of placing occupant safety at the center of all decision-making from the inception of new-build projects, rather than attempting costly and potentially impossible retrospective mitigations. The scope of stakeholders and the required knowledge base also need to be expanded and recognized. Consequently, it is proposed that ‘water safety groups’ should change their title to the ‘water/wastewater safety group’ to reflect this comprehensive approach. The article also calls for addressing risks from alternative, non-plumbed sources of water/wastewater contamination and for assigning clinical risk based on specific areas within the healthcare facility and patient populations.
This article serves as a crucial call to action, advocating for a holistic and redefined approach to water and wastewater management in healthcare, essential for safeguarding patient safety in the face of ongoing and emerging threats such as AMR.
Reference: Weinbren, M., Meda, M., Hopman, J., Fucini, G., & Sunder, W. (2025). Defining water safety in healthcare premises. Journal of Hospital Infection, 162, 301–309. https://doi.org/10.1016/j.jhin.2025.04.017
