This document

contains

pages

Health Technical
Memorandum 2027
Operational management

Hot and cold water supply,

storage and mains services

London : HMSO

111 Estates
An Executive Agencyof the Departmentof Health

 Crown copyright 1995

Applicationsfor reproductionshould be madeto HMSO
First published 1995
ISBN 011

3221797

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'I

About this publication

Health Technical Memorandum (HTM)

and distribution system. It

2027 provides recommendations,

advice and guidanceon the design,
installation and maintenanceof hot
and cold water distribution systems in
healthcare premises. It is applicable to
new and existing sites, and is for use
at various stages during the inception,

summarises the technical

aspects involved;
b. Design considerations
does not set out to give

instruction in design work but

highlights the overall
requirementsand
considerations that should be
applied to the design up to the
contract document;

design, upgrading, refurbishment,

extension and maintenance of a

building.
HTM 2027 focuses on the:
c.
a. legal and mandatory

details the

requirements;

requirements

for

ensuring that the supply,

storage and distribution
system is formally tested and

b. design of systems;
c.

Validation and verification

certified as to contract and

manufacturedto the highest

maintenanceof systems;

d. operation of systems.

level of quality assurance. The

It is published as four separate

volumes, each addressing a specialist

importanceof commissioning
is emphasised and the
minimum of tests on site are

discipline:

listed;

a.

Management policy details

the overall responsibility of

d. this volume Operational

management provides

managers of healthcare

information for those

premises and their legal

obligations in setting up and
operating a reliable water

responsible for overseeing and

operating day-to-day running

and maintenance. Safe

supply, storage

systemsof work, record-

keepingand legal obligations

c.

are included.

the National Health Service in

Scotland Management
Executive;

Guidance in this Health Technical

Memorandum is complementedby

the library of National Health Service

Model Engineering Specifications.
Users of the guidance are advised to

refer to the relevant specifications.

The contentsof this Health Technical
Memorandum in terms of

managementpolicy, operational
policy and technicalguidanceare
endorsed by:
a. the Welsh Office for the NHS

in Wales;

and they set standards consistent with

Departmental Cost Allowance Guides.
This HTM was written with the advice
and assistance of experts in the NHS

and industry.
Referencesto legislationappearing in
the main text of this guidanceapply in
England and Wales. Where references
differ for Scotland and/or Northern
Ireland, these are given in marginal
notes.

Where appropriate,marginal notes

are also used to amplify the text.

b. the Health and Personal Social

Services Management

Executive in Northern Ireland;

'V

Contents

Aboutthis publication

6.

Water economy page 20

Leaks

1.
1 .8

Introduction page3
Definitions

6.1
6.2
6.3

2.

Operationalconsiderations pages

7.

2.2
2.3
2.4

Emergency action page21

Legal
8.

Protectionofstaff page22

9.
3.
3.1

Cold watersystems page6

Sources of watersupply

3.4
3.8
3.12
3.14
3.19
3.23

Water treatment
Metalcontamination
Filtration
Water softening
Disinfection
Water storage

Responsibilitiesof maintenancepersonnel
page23
Designatedstafffunctions

Operational
Economic

3.34 Pressurisation/supply pumps

3.36 Distributionpipework
3.38 Temperaturecontrol
3.40 Metering
3.43 Monitoring

9.1

9.2
9.3
9.5
9.9
9.10
9.11
9.12
9.13
10.

Management
Infection control officer
Nominated person
Maintenancetechnician
Tradesperson
Installer

Contractor
Contract supervisingofficer
Record-keeping

page 25

References page26

4.
4.1

Hotwatersystems page 15
Hotwatercalorifiers
4.2 Hotwatercirculating pumps
4.5
4.6
4.7

Traceheating

5.

Other operational considerations page 18

Showers

Temperaturecontrol

Hydrotherapypools,whirlpool baths and spas

5.8 Temporaryclosureofwards/departments
5.9 Ice-makingmachines, watercoolersand drinksvending machines
5.1

Cisternflushing
Other economy measures

Other publicationsin this series page28

AboutNHS Estates page29

Page blank
in original

1.0 Introduction

1.1

This volumeoutlines the principlesinvolvedin the operational management

ofthe hotandcold watersupplyanddistribution systems for healthcarepremises.

It includes cold waterstoragecisterns,hot waterstoragecylinders andheat
exchangers, togetherwithwatertreatment and pressurisationunits, pipework
systems and circulation pumps. This volume will apply to all healthcarepremises,

butsome deviationmay becomenecessary wherethedifferingrequirementsfor

thevariouswaterundertakings must be met. Distributiondesign in healthcare
premisesmayvary, as for instancein systembuilding hospitalmanualsfor cold
waterservices systems, but the principleslaid down in this memorandumshould
beobserved.
1.2 Although manyof its recommendationswill be applicable,thisdocument
does notsetoutto coverfire-fighting services, nor watersupplyfor industrialor
otherspecialistpurposes, otherthanto indicateprecautionsthat should be taken
when theseare used in association with otherwaterservices. The pointat which a
domesticactivity becomesan industrialprocess, for examplein food preparation,
has not beendefined, andthe applicabilitywill needto be consideredin each
case.

1.3 As well ascomplying with the recommendationsoutlined in this document,

any workrelating tothe operational managementof the hot and cold water
services, new or extended,in any healthcarepremises should also complywith:

a. the current model waterbyelawsofthe localwater undertaking;

b.

BS6700: 1987, the BritishStandardspecificationfordesign, installation,

testing and maintenanceof services supplyingwaterfordomesticuse

within buildings and their curtilage.

1.4

In 1989 newwaterbyelawscameinto effectand theseare set out, along

withthe waterindustry'sinterpretation oftheseprovisions,in the 'WaterSupply

Byelaws Guide 1989'. The WRc(Water Research Centre)operatesthe Evaluation
and TestingCentre which provides adviceon byelawson a national basisand
administersthe Water Byelaws Scheme which testsand listswaterfittingsand
materialsforcompliancewith thebyelaws.The 'WaterFittingsand Materials
Directory' contains information on suitablefittings and materialsand is updated

everysix months.

1.5 It is required that any persons proposing to carryout works on cold water
distribution systems liaise closelywith the waterundertaking.
1.6 Where existingfacilitiesdo not meet the standardsrecommendedinthis
memorandum, managementshould carryout a risk assessment to establishthe
extent and priority ofaction requiredfor compliance.Action must then betaken
to meet these recommendations.

1.0 Introduction

1.7 Whilst someguidance on the waterservices applications mentionedbelow

is given in this memorandum, it is not intended to coverthemfully:
laundriessee Health Building Note 25;
sterilesupplydepartmentssee HealthBuilding Note 13;
hydrotherapypools see Public HealthLaboratoryservicebooklet 'Hygiene
for HydrotherapyPools'

Definitions
1.8 Definitionsof terms are asthosecontained in BS6100 Sections 2.7 and 3.3,
BS6700 and the Model Water Byelaws.

2.0 Operational considerations

Thereare three fundamental reasons forcarryingout maintenance: legal,

operational and economic.
2.1

Legal
2.2

Complying withthe lawis generallygiven thehighest priority and isoften

seen as theminimum requirementthat must be satisfied. The Model Water

Byelaws prohibitthe installationor useofany fitting which mightcause waste,
contamination or undueconsumption of the watersupply.There arealso laws

concernedwith health and safetysuchasthe Healthand Safety at Worketc Act,

the COSHH regulationsetc. Functional testing of equipment must be carried out
to ensurethatit will operate when required, suchas thetesting of safetyvalves on
calorifiers.Maintenancework should becarried out in an approved and safe
manner.

Operational
2.3 Maintenance is undertakento ensurethecontinuing, satisfactoryand
availabilityof services for staffand patients.

Economic
This maintenancework isassociated with ensuringthat the required
efficiency is obtained fromthe plant and that the plant achieves its optimum
economic life.

2.4

2.5 In orderto decide the appropriate level of maintenance(forexample

scheduled, correctiveorcondition-based)for the differentitems ofplant,the
following questions must beaddressed:

a. isthe breakdown ofa particularservicegoingto prove critical during normal

working hours oroutside normal hours?;

b. how longcan a breakdown of particular plant be tolerated?;

c. whatcost can be justified toavoid breakdownofparticular plant suchas
standby pumps?
2.6 The answerstotheabove questionswill set the objectivesfor the
maintenancepolicy. If response to failure is critical for certain items of plant, the
maintenanceorganisationwill require a planned strategyofcalling outskilled
stafftoachievean agreedresponsetimeand to minimisethe interval between
breakdown and the diagnosisand repairof the plant.

3.0 Cold water systems

Sources of water supply

3.1 The sourceof watersupply may be either from a connection to thewater
undertaker'sdistribution supplysystem orfrom a private supply.
3.2 Private watersupplies will principallybe fromlocal boreholessinceother
sources suchas rivers, springsetc are unlikelyto beeconomicallyviable as a
sourceofsupplyfor potable water.
3.3 It isthe responsibilityofthe NationalRivers Authority(NRA) to ensurethat
water resources are managedeffectively.The NRA fulfilsthis role principally
through the useofa system of waterabstractionlicences. Anyorganisation
wishing to drawsignificantquantities ofwaterfroma surfaceor underground
sourcemust obtain a licence to do sofromthe NRA.

Watertreatment
3.4 The need for watertreatment and the method of applicationdepend on the
purposesfor which the wateris to be used and thequantityrequiredfor each
purpose.Whilst potability is not normallyaffected bysuch characteristics as
hardness, colour, and (within limits) smelland/or taste, a measure of treatment
may be necessary to provide a more acceptableand wholesome supply.
3.5 A supplyfrom a waterundertakershould not normally requireany further
treatment whenused for healthcarepremises purposesotherthan forprocessing
for laundries,domestic hot watersystems and steam boilerfeed water, where
either the degreeof hardnessproves excessive or exceptionalsoftnesscauses
corrosion. Most privatesupplies,however, require somemeasure of treatment,
and in manycases the installation of pumping and treatment plant needs to be
extensiveto ensurea constantacceptablequality.
Chemical conditioning systems which are used in conjunction with potable
watersystems should be selectedverycarefully.Additionof any substancemust
not causea breachof any requirementsin theWater Supply(WaterQuality)
Regulations 1989 (asamended),and any systemfor introducing asubstancemust
be listed in the current edition ofthe Water Fittingsand MaterialsDirectory.

3.6

3.7 Automatic watertreatment systems should be fail-safeand have sufficient

instrumentationto monitor theiroperation. Where automatic equipment is used
fordisinfection it should indicateany change in the amount or concentration
delivered into thewater. Forexample, ultra-violet (UV) systems should incorporate
a UV detector so thatany loss of transmissioncan be acted upon immediately.

Metal contamination
3.8 Analyticalresults have shown that there can be a seriousproblem fromlead
contamination of hospitalwatersupplies. The 1993 edition oftheWorldHealth
Organisation'Guidelinesfordrinking-water quality'has lowered its guideline
value for lead, from0.05 mg/Ito 0.01 mg/i. The WHO guidelinesvalue is likely to
be exceeded iflead pipes are present, or if copper pipes have beenjoined with
solder containing lead. In generalterms ifhospital drinking watercontains more
than 0.05 mg/Iof lead then remedialaction should be considered.
6

Northern Ireland: Equivalentprovisions

areproposed for Northern Ireland
(Oct93)
Scotland: The WaterSupply (Water
Quality)(Scotland) Regulations1990
withamendments

3.0 Coldwatersystems

3.9 Copper concentrationsabove 1 mg/i maycausestainingof laundry and

sanitaryware, and increase the corrosionof galvanised iron and steelfittings.
Whilst the maximumallowable copper concentrationin drinking wateris3.0
mg/I most supplies will give a level atthetap of less than 1.0mg/I.
3.10 Water supplies tocertain unitssuchas maternity, neo-natal, paediatric,
general paediatricand renaldialysisunits must notbecontaminated by copper or
heavymetals in excessof 0.05 mg/I.The aluminium contentof suchwater
suppliesshould alsobe monitored to ensurethat levelsarebelowacceptable
limits.
3.11 Where the watersupplyis known to dissolve metals, regularsamplingtests
should be made atstrategicsamplingpoints toascertainthat the level of metal
contamination in the watersupplyto thehealthcarepremises, plus any added
during itspassage throughthe healthcarepremises distribution system,does not
result in limits above thestated safe levels. Thiswill especially apply if the
healthcarepremises distribution pipework includesa multiplicity of leadedsolder
capillaryjoints. In softwaterareas, metalcontamination can occurbysimple
dissolution.Pitting corrosionarising in hard waterareas, as a result of deleterious
carbonaceousfilmslaid down during themanufacturing process, does not
normally give rise to elevated copper levels in thewaterand is not nowadaysa
problem ifthird partycertified tubes to BS2871 Part 1 are used.

Filtration
3.12 Filtration ofpotable watertoa particlesize of 0.2 micronsisnot
uncommon, typicallyusing "dead-end" filters orcross-flow membranefilters.
3.13 In all cases it isfeasiblefor bacteriato colonise or "grow through"the filter
materialeven where backwashingis a feature. It is essential for filtercartridge
elementsto bechanged at appropriate intervalsin accordancewith the
manufacturer's recommendations,taking into account local conditions. Filter
membranesshould also bechemicallycleanedorreplacedat the recommended
periods,and care must be taken to ensurethat the "vessel"or "housing"
containing the filterassemblyis alsodisinfectedappropriatelyduring filteror
membranemaintenance.

Water softening
3.14 Hard waters are sometimesunsuitablefor many industrialand domestic
purposes. Treatmentmay therefore be necessary to removeor alter the
constituentstorender the watersuitablefor particularpurposes.
3.15

Base exchangesoftening removes permanentandtemporary hardness

fromwater.The techniqueuses an ion exchangeprocessin which thecalcium and
magnesiumions in solution areremovedand replacedbyan equivalentamount of

sodium ions.
Dailyorfrequent backwashingand periodiccleaning and disinfection
(six-monthly)must be undertakenin accordancewiththe manufacturer's/
supplier's instructionswhich may requireusing chlorine (20 mg/I). Other
proprietary cleaningagentsare not recommended,particularly ifthesoftened
supplywaterserves apparatussuchas dialysis units.
3.16

3.0 Coldwatersystems

3.17 Other watersoftening methods include physicalwaterconditioning and

magnetic waterconditioning. The operation and maintenanceof thesesystems
should be in accordancewith manufacturer's instructions.
3.18 Furtherinformation on watersoftening can be found in BSRIAApplications
GuideAG 2/93 'Water Treatmentfor BuildingServices Systems'.

Disinfection
3.19 Normallya supplyfrom a waterundertakershould not requiredisinfection,
but all piping, fittingsand associated services used forthe conveyance of water
for domesticpurposesmust be disinfectedbefore being brought into use. Such
piping, fittingsand storagecisterns must also be disinfectedon completion of
works which have entailed "opening up" the system. Privatewatersupplies must
be disinfectedbefore being used fordomesticpurposes. Disinfection is effected
bychemicalor physical agents;the method generally used is chlorination.
3.20 Disinfectionusing chlorine should be carried out in accordancewith the
guidance given in the 'Validation and verification' volume of this HIM, and under
the direct supervisionof a nominated person.
3.21 The continuous chlorinationof hot and cold waterservicesystems to
control the growth of legionellaeis not recommendedunless it issuspectedthat
theyare the sourceofcases of hospital-acquiredlegionellainfection.
3.22 Contaminatedwaterthat is run towaste intoa natural watercourse,ora
drain leading to it, should be treated in accordancewith the requirementsofthe
authority responsible for land drainageand pollution control. The authority
responsibleforthat sewer should be informed. Dechlorinationcan beachieved
using either sulphur dioxide or sodiumthiosulphate. 20g of sodiumthiosulphate
crystals are requiredto dechlorinate500 litresofwatercontaining 20 mg/I free
chlorine.

Waterstorage
3.23 The quality of stored waterneeds to be preserved to avoid microbial
contamination and otherloss of quality. Special attention should be given to all
cisterns, tanks or other devices used to storewater. It is necessary to minimise
stagnation and stratification of thestored water. A maximumof 12 hours' total
on-site storagecapacityis recommended.The quantityof waterstored should be
carefully assessedin relation to thedaily requirement in orderthat a reasonable
rate of turnover is achieved. Storageof unnecessarily large quantities of potable
waterwill result in low ratesof turnover anda consequentdeterioration in the
quality of water. The storagecapacityshould be reducedwhere it is known or
establishedthat it is excessive and where it is practicableto do so; an example
wouldbe where there aretwo cisterns in parallel, one of which can be left empty
and blanked-off (pipesections should be removed). Alternatively,the steady
waterlevel inthe cisterns should be lowered;this can be achieved easily if the
float controlling the watersupplyhas a thumbscrew adjustment as prescribedin
BS1212:Part 1. The design capacityshould not allowfor future extensions.
Pipeworkconnectionstoand fromthe storagesystems should bearrangedto
encouragegoodcirculation within the system.
Delayed action floatoperated valves may help toensurethat stagnation is
reduced.

3.24

Additionaladviceon the use ofan

alternative disinfectant in Scotland, is
given in 'Domestichotand cold water
systems forScottishhealth care
premises'SHTN 2

3.0 Coldwatersystems

3.25 Storagecisternsshould be located to minimiseheat gains.To restrict

microbiologicalgrowthit is important that the temperature of stored wateris
keptas low as practicable,ideally not more than 20C.
3.26 Every cistern must be providedwith a properly-fitting coverand any pipe
open to the atmosphere,for examplethe overflow, must beproperly screenedas
required bythe waterbyelaws. A sketch illustrating generalpotable waterstorage
cistern requirementsis contained in Figure 1.
3.27 All cold waterstoragecisterns and cold feed cisterns must be regularly
examinedthose containing less than 1000 I at leastevery12 months and those
containing more than 1000 I atleasteverysix months, paying particularattention
to the presenceof foreign objects,biological materialandexcessive corrosion. On
completion ofthe examinationsthe cisterns should becleaned and any remedial
workcarried out. Before the cisternsand system are put back into usetheyshould
be disinfected in accordancewith the procedure detailed in the 'Validation and
verification' volumeofthis HTM.
3.28 Any chemicalsused in thecleaning or maintenanceof cisterns must be of a
type consideredacceptablefor potable wateruse.
3.29 Where potable waterhasbeen stored inan inadequatelyprotected cistern
a wateranalysis should be considered.In multiple cistern installationsa check
should becarried out for stagnantwater,usuallyapparent byodouror a dusty
surface. Ifthis is foundto be the casethe cisterns should beflushed out and the
inlet and outlet connectionsrearrangedsothat flow is sequentialand the problem
does not recur.
3.30 Cistern insulationshould becheckedtoensurethat it is in goodcondition
and adequatelypositioned.
3.31 Floatoperated valves should be checkedto ensurethat theyare securely
fixedand set to achieve a correct waterlevel in accordancewith thewater
byelaws.

3.32 Overflow/warning pipesshould be checkedto ensurethat theydo not rise

in level and theyareclear and correctly routed togive an obviousvisualalarm of
anoverflowcondition. Aweatherproof labelfixed adjacentto thewarningpipe,
identifying the tankand its location together with the person/departmentto be
contacted in the event of a discharge, wouldcontribute to a quick and accurate
defect reportwhich could then be acted upon, so minimisingwaterwastage.

Aschematicdrawing, illustrating piping andvalvearrangementsfor break

tankoperation during normal running and maintenanceperiodsis included in
Figure 2 of thisvolume.
3.33

Pressurisation/supplypumps
3.34 Where two or more pumps are installedfor pressurising systems,
automatic control should be provided to sequence the pumpsto ensurethat each
pump is regularlybroughtinto service (at leastdaily) as the main dutyor lead
pump, in orderto minimiseany danger ofstagnation.
3.35 The maintenancecarried out on this type of equipment should be in
accordancewith the manufacturer'srecommendations.

3.0 Cold water systems

AIR GAP CONFORMING

TO WATER BYELAWS.
TIGHT FITTING, OPAQUE, AND
RIGID ACCESS COVER,
SECURED TO CISTERN.

CISTERN SUPPLIED DIRECT

FROM SERVICE PIPE, OR
PUMPED FROM SIMILAR
CISTERN AT LOW LEVEL.

SCREENED OVERFLOW!
WARNING PIPE.

CISTERN TO BE
INSULATED.
CISTERN TO BE
ADEQUATELY SUPPORTED.

DISTRIBUTING PIPE.

NOTE
CISTERNS SHOULD BE SITUATED AWAY FROM HEAT SOURCES.
ACCESS SHOULD BE PROVIDED FOR INSPECTION AND MAINTENANCE
(BOTH INTERNALLY AND EXTERNALLY).

Figure 1

GENERAL POTABLE WATER STORAGE

CISTERN REQUIREMENTS

3.0 Coldwatersystems

(A)
INCOMING

BREAK
TANK

DRAIN

DRAIN

(B)
INCOMING

BREAK

TANK

DRAIN

DRAIN

NOTE
BREAK TANK CAN BE MAINTAINED DURING RUN DOWN OF MAIN TANK FROM FULL.

PIPING AND VALVE ARRANGEMENTS FOR BREAK TANK OPERATION

(A) NORMAL RUNNING (B) DURING MAINTENANCE
Figure2

'Il

3.0 Coldwatersystems

Distribution pipework
3.36 System schematic drawingswith valves numbered and labelledwill reduce
confusion and savetime in tryingto identify appropriate isolatingvalves and other
systemcomponents.The schematic should be mounted in a frame and displayed

in theappropriate plantroom.
The followingchecksand actionsshould be carried outtoshowthat:
a the system componentsshownosign of leakageorcorrosion;

b. the system insulationis in goodcondition;

c. the system filters have beenchanged and/or cleanedin accordancewith
manufacturer'srecommendations.Regularlycheck and clean strainers;

d. all isolatingvalves have periodicallybeenworked throughtheir full range of

travel;

e.

emergency deluge showersand eye baths are regular(weekly)flushed to

preventstagnation of thewaterin pipework servingthisequipment;

f. everywateroutletcomplieswith the backflow protection requirementsof

the waterbyelaws.
3.37

A schematic drawing illustrating a hot and cold waterservices distribution

system is included in Figure 3 ofthisvolume.

Temperature control
3.38 The temperatureofwaterstored in cisternsshould be maintainedbelow
20C, as far as ispracticable,to minimisebacterialgrowth.Storage installations
should beinsulatedand protected fromthermal gains.
3.39 The temperature ofthe cold waterservice should be checkedat leasttwice
a year.Tests should include:
a. measuringthe incomingwatertemperature atthe main watermeter;

b. testing the inlet, outletand surfacewatertemperaturesof cisterns andcold

waterfeed/headertanks for thehot watercalorifiers.The temperature
should not begreater than 2C above that measured
at(a);
c.

at cold waterdraw-offpoints a temperature of not greater than 2C above

thetemperature measured in thestoragecistern should be reachedwithin
one minute of running thewater.

Metering
3.40 Where watermetersare installed in below-ground meterchambers,
ensurethe chambers are keptclean of debris and water; thiswill enablequickand
accuratereading ofthe meters.

12

3.0 Coldwatersystems

VENT

'A' TYPE AIR

GAP

WATER SUPPLY

TUNOISH

COLD FEED PIPE

VALVE

HOT WATER SUPPLY

BASINS

DRAIN
BATH
SECONDARY CIRCULATION PUMP
NON-RETURN VALVE

HOT WATER RETURN

DRAIN
NOTES
1.

ALL PIPEWORK TO BE INSULATED.

2.

ISOLATING AND CONTROL VALVES NOT SHOWN.

3.

ALL DRAINS SHOULD DISCHARGE TO WASTE VIA A TYPE

Figure

'A'

AIR GAP.

SCHEMATIC HOT AND COLD

SERVICES DISTRIBUTION

AT

> 501

LOWEST POINT

3.0 Coldwatersystems

3.41 Periodically check that metersare actually working and giving accurate
readings.

3.42 Meters, other than thewatersupplier's meters, should be removed at such

intervalsas recommendedbythe manufacturersforcleaning and renewalofworn
parts and should betested for accuracy priorto replacement.

Monitoring
Read meterson a regular basis (monthly) and monitor consumptions;a bar
graph will highlight unusuallylargeconsumption, which can then be investigated.

3.43

Check the consumptionon the utilitybill againstthat indicated bythe

regular meter readings,and investigatediscrepancies.

3.44

3.45 Regularlycheck system componentsforsignsof leakage; a tap left

dripping can waste in excessof 14,000 litres of watereach year.
3.46 Regularanalysis of watersamplesat six-monthly intervalsshould be carried
out whereverbulk drinking waterstorage exceeds 1000 I and is suppliedfromthe
water undertaker. Supplies taken from local boreholesetc should be tested to
comply with the requirementofthe Private Water Supply Regulations. Additional
checks/analysis should becarried out afterany repairsormodifications to the
system. The results of all analysis should be keptand recorded.

14

4.0 Hot water systems

Hot water calorifiers

Calorifiersshould be subjectedto regularcleaningand maintenance
procedureswhich includethe following:
4.1

quarterly draining to minimisetheaccumulationofsludge.This

frequency may be extendedto annual if, during inspection,it is found
that thereis littleaccumulationof debris;

wheneverdismantled,for statutory inspectionor everyyear in the

caseofwater/water calorifiers,calorifiersshould bethoroughly
cleanedtoremovesludge and loose debris (it is notessential to
removeall scale);

whenevera calorifieristakenoutof service, or itsflowtemperature

falls below45C for any reason, it should be refilled, drained, refilled
again and theentirecontents broughtup to and held at the nominal
operating temperature of60C for at leastone hour. A calorifier shunt
pumpwill significantly reducethe heat-up time. The calorifier should
remain isolateduntil the procedureis completed. When bringing
calorifiersback on line, it is important that service valves are opened
slowly toavoid any disturbanceofsedimenteddebris. Calorifiers
which are to be taken out of service for more than a few daysshould
be drainedand should not be refilled until ready for return to service.
The drain valveshould be left open throughoutthe period the
calorifier isout of use;

usersare reminded that ifa calorifieris colonisedby legionellaeand is

thendrained and opened for maintenancepurposes, there can bea
risk of infection to maintenancepersonnel;

where it is known orestablishedthat grossover-capacityexists in a

calorifier, and where it is practicable to do so, it should be removed;

a schedule ofapproximate calorifieremptying times is includedas

Table 1.

Hot water circulating pumps

4.2 Circulating pumpsshould be of adequateperformancetoensure a
minimum available temperature at draw-offpoints at 55Cand an absolute
minimum of 50Cforthe control of, for examplelegionellae.

In circumstances where it is impracticableto removepumps(thatis, when

leavingthe standbypump availablefor immediateconnection into the HWS
circulating system), thepumps should beswitched daily to ensurethat any
standby or back-up pump is regularly brought into service as the main dutyor lead
pump. It may be more effective to utilisean auto-changeoversystem, inwhich
casemore frequent switching wouldbe appropriate.
4.3

It is not permissibletoshutdown the pumped circulation system. Todo so

will lead to the loss of the requiredsystemtemperatures.
4.4

15

4.0 Hot watersystems

Calarofier

Diameter/length

type

ratio

Horizontal

Horizontal

1:2.5

1:1.5

1:1.5

Vertical

Capacity
litres (gallons)

Drain valvesizes mm (inch)

25(1.0)

38(1.5)

13,500 (3,000)
9,000(2,000)
4,500(1,000)
2,250 (500)
1,800 (400)
1,400 (300)

3 hr 15 mm
2 hr 15 mm

13,500(3,000)
9,000(2,000)
4,500(1,000)
2,250 (500)
1,800 (400)
1,400 (300)

3 hr 00 mm
2 hr 10 mm

13,500(3,000)
9,000(2,000)
4,500(1,000)
2,250 (500)
1,800 (400)
1,400 (300)

2 hr 45 mm
2 hr 00 mm

hr 15 mm
45 mm
35mm
28mm

hr 30 mm
hr 00 mm
30 mm
20 mm

45 mm

15mm

9mm

12mm

7mm

hr 20 mm
hr 00 mm
30 mm

45 mm

30 mm
20 mm
10 mm

30 mm
20 mm

17 mm

10 mm

32mm

14mm

8mm

25 mm

11 mm

6 mm

hr 15 mm

hr 10 mm

30 mm

40 mm
30 mm
20 mm

38 mm

17 mm

9mm

31

14mm

8mm

11

6 mm

mm

25 mm

2. The drainfromthe gully should beof sufficient sizetotake theflowfromthe calorifierdrain.

Emptyingtimes forcalorifiers(approx)

Trace heating
4.5 Electrical trace heating should be checkedroutinely (at leastannually)to
ensurethat itmaintains the watertemperature above 50C. Careshould be taken
to ensurethere are no cool spots.

Showers
4.6 Hyperchlorinationof shower heads and angle valvestrainershas only a
short-livedeffecton legionellae.Automatic drainvalves are ineffective in
maintaining a reduction in the number of legionellaein shower water. Regular
flushing of showersreduces legionellae.The most effective managementof
showerswill be achieved by the removal of unnecessary ones and the regular use
of others.

Temperaturecontrol
During a period of low ambient temperature,check thetemperaturesof the
outflowfrom the HWScalorifierto establishthat the temperature is above60C
and that the temperature at the return connection is not less than 55C. The most
distant draw-offpoint on thesystemshould be checkedto ensurethat the
4.7

temperature reaches a steady state value between 60C and 50C within one
minute of running the wateratfull flow. Appropriate remedial action should be
taken where necessary.

16

hr 10 mm
39 mm

Times assume nohose and simplegatevalve.

Notes 1. Balltype valve(s) should bespecified toavoid "clogging".

Table I

50(2.0)

55 mm

mm

4.0 Hot watersystems

4.8 Although the Healthand Safety Executive in HS(G)70 recommendsspot

checks,thisguidance requiresatemperature excursionlimitof less than 20
minutes. Thereshould be no more than two excursionsin any 24-hour period;
therefore, continuous monitoring is recommended.
4.9 Where there is a building managementsystem,

itcould be used to monitor

temperatureswithinthe system.

It is essential to checkthe temperature settingsand operation of all water

devices
mixing
routinely, at leasthalf-yearly.Other maintenanceshould be strictly
4.10

in accordancewith the manufacturer'sinstructions.The localwaterquality will

influence the maintenancefrequency for any installation.A relativelysmall piece
ofdebris may restrictthe operation ofthetemperature control and fail-safe
mechanisms.

4.11 Recommendationsregardingsafewaterandsurface temperaturesgiven in

NHSEstates' HealthGuidanceNote "Safe" hot waterand surface
temperatures', apply to all ward accommodation,residents'rooms and those
areas to which patients,residentsand visitorshavefree access (including public
areas). Untiltherecommendedprecautionsare put into effect, staffshould be
made aware of the potential danger and takethe necessary stepsto protect
patients, residentsand visitors.Areas which do not meet theserecommendations
should be identified, and plans to comply as soon as reasonablypracticableshould

be devised.

17

5.0 Other operational

considerations

Hydrotherapy pools,whirlpool baths and spas

5.1 Hydrotherapypools,whirlpool baths and whirlpool spas provide conditions
which potentially favour the growth of legionellae.While there have been no
reported cases of legionellaeinfection implicating hydrotherapypools, there have
been several outbreaksassociated with spa pools or whirlpools. These are
particularlyvulnerablebecause ofthe smallvolumeofwater in circulation and the
multi-occupancy(typically three to sixpersons) makes an outbreak more likely.
Careful maintenanceand chemicaltreatment is essential to maintainwater
quality. Alog must be keptof the treatment, filtercleaning and the results of tests
for pH, free residual halogenand other treatment parameters.
5.2 Spa bathsand whirlpool baths which provide a single fill for each individual
use do notappeartopresentthe samehazard. There remainsconcern, however,
about retention ofwaterin thesesystems; an InternationalStandardto coverthis
subject is proposed.
5.3 Regular cleaningand periodic disinfectionin accordancewith
manufacturer'sinstructions is recommended.
5.4 The Swimming Pool andAlliedTrades Association(SPATA) will provide
adviceonthe operation ofwhirlpool spas.
5.5 All staffwho operate/maintainthis type of equipment should receive
adequate training to ensurethat appropriate safety proceduresand effective
watertreatment regimes are adopted.
5.6 Adviceonthe operation of hydrotherapypools iscontained in 'Department
of Rehabilitation,a DesignGuide, publishedbythe DHSS in 1974. More recent
information iscontained inthe Central SterilizingClub's, 'Hygienefor
HydrotherapyPools', publishedin 1990 and in the Public HealthLaboratory
Service booklet 'Hygienefor HydrotherapyPools'.

5.7 Maintenancefor this equipment should be carried out in accordancewith

the manufacturer'srecommendations.

Temporary closureof wards/departments

During temporary closureofwards or departments,a procedurefor
flushing the hot and cold waterservice systems should be instituted. This should
include opening all taps for a period ofthree minutes and flushing WC cisterns,
etc on a weekly cycle.Alternatively,whenthis is impracticable,the disinfection
procedure recommendedfor new installationsmay be carried out immediately
priorto occupation.
5.8

18

5.0 Other operationalconsiderations

Ice-makingmachines, water coolersand drinks-vending

machines
5.9 Maintenancefor this equipment should becarried out in accordancewith
the manufacturers recommendations.
5.10 The equipment should be positioned so that thewarmairexhaust does not
impinge directly on taps or hoses supplyingcold water.
Ensurethat the watersupplytothisequipment is taken froma potable
supply.Where equipment is hand filled,there should be clear instructionson the
waterused.This should be fromthe mainssupply and collectedand decantedinto
theequipment froma cleanvessel, and in a hygienicmanner.
5.11

5.12 Ice should not be allowed to stagnate in an ice-makingmachine'sstorage

bin, but should bechanged frequently.

19

6.0 Water economy

Leaks
Monitor consumption; if it increases for no readilyidentifiable reason, this
indicate
a leak.Underground leaksmaybe identified by:
may

6.1

a. wet or soggypatchesof ground;

b.

areas ofgrassthat aregreenerorgrowingstronger and more quickly than

the remainder;

c. waterin stopvalvechambers.

Cistern flushing
6.2 Ensure that the amount of waterused as a result offlushing cisterns
complieswiththe waterbyelaws.

Othereconomymeasures
6.3 Thereare a number of other economy measures which may be
implemented;theseinclude:

thefitting of flow restrictorsto hand-basin taps, or fittingspraytaps;

proximity detectorsand timing devices controlling the flushing of
urinals;

considerreplacing bathswith showerswherethis isa practicable

propositionshowers usesignificantly less waterthan baths;

minimisedead-legson the hot service to hand-basins. The cold water

in thesesections is usuallyrun off to drain whilewaiting for the hot

waterto arrive;

20

ensurethat bathsand sinks are fitted withwaste plugs to discourage

wasteful run-off;

ensurethat systems are adequatelyfrost-protected and wellmaintained;

useposters, etc to raise awareness ofthe need for watereconomy

and discouragewasteful practices suchas leavingtaps running. The
postersareavailablefromthe Departmentofthe Environment.

7.0 Emergency action

7.1
a.

Contingencyplans should beavailablein the event ofthe following:

a power failure affecting distribution/circulatingpumps;

b. a mainswaterfailurewhich could endurebeyond the period offered bythe

storage capacity.
7.2 The followingsectionextractedfrom HIM 2040indicatesthe courseof
action to befollowedif an outbreak of legionnaires'disease is suspected.
7.3 The nominated person will usually be informed of a suspectedcase of
legionnaires'disease possiblyassociated with healthcarepremises by either the
infection control team or the local Consultant in CommunicableDisease Control
(CCDC). If a case issuspected, the hospitaloutbreak team will normallywork in
associationwith the Public Health LaboratoryService and the local CCDC to
search for thesourceof the causativeorganism.It isessential that systems are not
drainedor disinfectedbefore samples have beentaken. The nominated person's
role is an important one guiding the team to thevariouswatersystems within
thebuilding and, in particular,tothe points fromwhich samples can be taken.
Easyaccess to thesesamplingpoints is essential.
7.4 The investigationwill concentrateupon all potential sourcesofIegionella
infection, including:

the domestichotand cold waterdistribution systemincluding cold

waterstoragesystems;

wet spraycooling-water systems;

showers orspray-washingequipment;
drainagesystems and traps;
spas, whirlpool bathsor therapy pools;

humidifiers in ventilation systems;

cooling coilsin air-conditioning systems;
fountains and sprinklers.

7.5 Toassistin such investigations,the nominatedperson must be able to

provide detailsof all associated equipment, including all documentation. He/she
must assist byadvisingthe investigatingteam on the extent of servicing on the
site, and by locatingtaps and samplepoints.
7.6 The nominated person must also identify the locations ofany medical
equipment usedfordental care,respiratorytherapy and within haemodialysis
units, etc.
7.7 Off-site information will also be required, suchaswhether there have been
any local excavationor earthmovingworks, alterationsto watersupplysystems or
drainagesystems, orany otherfactors which may have a bearingon the site.
7.8 The addressand telephone number of the nearestweather station will be
requiredthis is likelyto be a local airport, universityor collegedepartment.
7.9 The teamis responsible foridentifying the cause of infection, and will advise
on cleaning, disinfection,any modifications,and long-term control measures.
21

8.0 Protection of staff

8.1 All works carriedoutshall besubject to:

a. the Health and Safety atWorketcAct;

b. the managementof Health and SafetyatWork Regulations;
c. the Control ofSubstances Hazardous to Health (COSHH) Regulations;

d. the Water Supply Regulations;

e. the Public Health(InfectiousDiseases) Regulations;

f. the Provision and Use ofWork EquipmentRegulations.

22

9.0 Responsibilities of maintenance

personnel
Designatedstafffunctions
Management
Management is defined asthe owner, occupier, employer,general
manager,chief executiveor other personwho is ultimately accountableforthe
safe operation ofhealthcarepremises.
9.1

9.2 A person intending tofulfil any ofthe stafffunctions specified below should
be ableto prove that theypossess sufficient skills, knowledgeand experienceso
asto be abletoperform safely the designatedtasks.

Infection control officer

Infection control officeror consultantmicrobiologist if notthe same
person, nominated bythe managementto advise on monitoring infection control

9.3

policyandforthe maintenanceofwaterquality.

9.4 Additionallythe policyshould be acceptabletothe control ofinfection

committee and any amendment to that policymust be agreedbythecommittee.

Nominated person
9.5 Anominated person(water), possessing adequate professionalknowledge
and with appropriate training, should be nominated in writingby managementto
deviseand managethe necessary procedurestoensurethat the quality ofwater
in healthcarepremises is maintained. The personwill berequired to liaise closely
with otherprofessionals in variousdisciplines. In addition, the personshould
possess a thorough knowledgeof the control of legionellaeandwould ideally be
a chartered engineer.
9.6 This person'srole, in associationwith the infection control officerand
maintenancestaff, involves:
a. advisingonthe potential areas of risk and identifying where systems do not

comply with this guidance;

b. liaising withthewaterundertakersand environmental health departments

and advisingon the continuing procedures necessary to ensureacceptable
waterquality;
c. monitoring the implementationand efficacy ofthose procedures;

d. approving and identifying any changesto those procedures;

e. ensuringthat equipmentwhich isto be permanentlyconnected tothe
watersupplyis properly installed;
f. ensuringthat adequate operating and maintenanceinstructionsexist and
adequaterecordsare kept.

23

9.0 Responsibilities

of maintenancepersonnel

9.7 Implementationofan effective maintenancepolicy must incorporatethe

creation of fullydetailed operating and maintenancedocumentation and the
introduction of a logbook system. The "nominated person' should appointa
deputy to whom delegated responsibilitiesmay begiven. The deputy should act
forthe nominated personon all occasions when the nominated personis
unavailable.

9.8 The nominated personshould be fullyconversantwith the design principles

and requirementsof watersystems and should be fullybriefed in respectofthe
cause andeffectof waterborne organism,forexampleLegionellapneumophila.
The appointment of an engineeras the nominated personisappropriate in that
the responsibilitycan extend to the operation and maintenanceofassociated
plant.It isrecognisedthat the nominated personcannot be a specialiston all
matters and must be supported byspecialists in specificsubjectssuchaswater
treatment and microbiology, buthe/shemust undertake responsibility for calling
upon and co-ordinating theactivities ofsuch specialists.

Maintenancetechnician
9.9 A personwho, in the opinion ofthe nominated person hassufficient
technical knowledge and the experience necessary tocarry out maintenanceand
routine testing ofthewater, storageand distribution system.
Tradesperson
9.10 A personwho is appointed in writingbythe nominated personto carry
out, under thecontrol of the maintenancetechnician,work onthe water, storage
and distribution system.

Installer
9.11

A person or organisationresponsible for the provision ofthe water,

storageand distribution system.

Contractor
9.12 The person or organisationdesignatedby managementto be responsible
for thesupply and installation of hot and cold waterservices, and for the conduct
of the installationchecksand tests.

Contractsupervisingofficer
9.13 The personauthorisedby the hospital authority to witnesstestsand checks
under the terms of contract. He/she should have specialistknowledge, training
and experience ofhot and cold watersupply,storage and mainsservices and
HIM 2027.

24

10.0 Record-keeping

Postcommissioningdocumentation
forhealth buildings inScotland
ScottishHospital Technical Note 1

10.1 Managementshould ensurethat an accurate record ofall assets relating to

the hotand cold waterdistribution systems is set upand regularly maintained.
Theymust also ensurethat recordsofall maintenance,inspectionand testing
activities are keptup-to-date and properly stored.

10.2 Planned preventivemaintenancewill help to ensurethat systems perform

correctly,and an essential elementofthis process is the maintenanceofaccurate
records.

10.3 Maintenance records are normallyrequired for the followingpurposes:

a. verificationof maintenancefor local accountability;

b. verification of maintenancefor statutory obligations;
c. as a means of monitoring themaintenancepolicy and its effectiveness;
d. as a meansofobservingperformancetrends, helping fault diagnosisand
initiating correctiveaction where necessary;

e. asan aid to financial planning.

10.4 When alterationsto plant orsystems are implementedthe record drawings
should be updated to reflect themodifications carried out.
10.5 An asset registerfor theengineeringservices wouldprovide a structure for
recording,retrievingand analysinginformation.
10.6 The followingare someof thesignificant applicationsofan asset register:

as a plant inventory;

to provide a basisfor identifying plant details;

to provide a basis for recording the maintenancerequirements;
to provide a basis for recording/extractinginformation associatedwith
the maintenanceofan asset;

to provide a basis for an accountant to establishthe provisionthat

needsto be made for plant replacement;

forinsurancepurposes.

10.7 Furtherinformation on the monitoring of performanceand effectivenessin

carryingout maintenancetaskscan be foundin CIBSE Technical Memorandum
TM17: 1990, 'Building Services MaintenanceManagement'.

25

References

British Standards

Statutoryrequirements
Health and SafetyatWork etcAct 1974. HMSO

1974.

Model WaterSupplyByelaws.HMSO1986.

operated valves(copperalloy body) (excluding floats).

of Healthand Safetyat

SI 2051:1992 The Management

Work Regulations.

BS1212:1990 Floatoperator valves

Part 1: 1990 Specificationfor piston typefloat

BS2871

Specificationfor copperand copper alloys.

Tubes.

HMSO 1992.

SI 3246:1994 Control of Substances Hazardous

Health(COSHH) Regulations. HMSO 1994.

to

Part 1:1971 Coppertubes forwater, gas and

sanitation (AMD 1422, 5/74;AMD 2203, 11/76).

SI 2932:1992 The Provisionand Use of Work

EquipmentRegulations.HMSO1992.

BS6700:1987Specificationfor design,installation,
testing and maintenanceofservices, supplying water
fordomesticuse within buildings andtheir curtilages.

SI 1039:1978 (NI 9) Healthand Safety at Work

(Northern Ireland).HMSO 1978.

terms.

SI 374:1990 (NI 9) Control of Substances Hazardousto

BS6100Glossary of building and civil engineering

Section 2.7:1992 public Health. Environmental

Health(COSHH)Regulations(Northern Ireland).

Engineering.
Section 3.3:1992 Sanitation.

SI 1550:1988(5.155) PublicHealth(Notification of
InfectiousDiseases)(Scotland)Regulations.HMSO

Other pubiIcatlons

1988.

HealthBuilding Note 25 Laundry.HMSO

SI 1147:1989 Water Supply(Water Quality)

Regulations.HMSO 1989.

1994.

HealthBuilding Note 13Sterile services department.

HMSO 1993.

SI 1384:1989 WaterSupply (WaterQuality)

(Amendment)Regulations.HMSO 1989.

National HealthService Model Engineering

Specifications.NHS Estates 1993. (2 vols electrical,2 vols

SI 1837:1991 WaterSupply (WaterQuality)

(Amendment)Regulations. HMSO 1991.

mechanical).

51119:1990 (S.11) WaterSupply (WaterQuality)

Postcommissioningdocumentationfor health
buildings in Scotland (SHTN 1). Scottish Office, HMSO

(Scotland)Regulations.

1993.

HMSO 1990.

Sl1333:1991(S.129) Water Supply (WaterQuality)

(Scotland)(Amendment)Regulations.HMSO

1991.

Water Fittingsand MaterialsDirectory.Water Research

Centre, publishedevery6 months.

SI 2790:1991 PrivateWater Supplies Regulations.

HMSO 1991.

Watersupply byelawsguide. Water Research Centre,

SI 1546:1988 PublicHealth(InfectiousDiseases)

Dadswell,J. V. Hygienefor hydrotherapy pools. Public

Healthlaboratory Service, 1990.

Regulations. HMSO 1988.

512932:1992The Provisionand UseofWork

EquipmentRegulations.

HMSO 1992.

1989.

Guidelinesfordrinkingwaterquality:
recommendations.WorldHealth Organisation(WHO),
HMSO 1993.

26

References

Maintenancemanagementfor building services

(Technical MemorandumTM 17). CharteredInstitute of
Building Service Engineers, 1994.
Standards forcommercialspas: installation, chemicals
and watertreatment. Swimming Pool and AlliedTrades
Association, 1989.
Hygience forhydrotherapy pools: report of aworking
party on hygienefor hydrotherapy pools. Working
Partyon Hygiene for HydrotherapyPools, Central Sterilising
Club, HospitalInfection Research Laboratories, 1986.
Hejab, M. Water Treatmentfor Building Services
Systems Application Guide (AG 2/93). Building Services
Research and Information Msociation (BSRIA), 1993.

HealthGuidance Note "Safe" hotwaterand surface

temperatures.HMSO1992.

27

Other publications in this series

(Given below are detailsofall HealthTechnicalMemoranda

availablefromHMSO. HTMs marked(*) are currently being
revised, those marked(t) are out of print.Some HTMsin
preparationat the timeof publication ofthis HIM are also
listed.)

Anti-static precautions:rubber, plastics and

fabricst
Anti-static precautions:flooringin
anaesthetisingareas (and data processing
rooms), 1977.

3
4
S

Steam boiler plant instrumentationt

Protectionof condensatesystems: filming

aminest
Electrical services: supplyand distribution, 1993.

2007
8
9
2010
2011

Pneumaticconveyorsystems*

16
17

Sterilizers, 1994.

60

Ceilings, 1989.

61

Flooring*
Demountablestoragesystems, 1989.
Fittedstorage systems, 1989.
Sanitaryassemblies*
Healthsigns*
Cubiclecurtain track, 1989.
Laboratoryfitting-outsystem, 1993.
Ductsand panelassemblies, 1993.
Protection, 1993.

62
63
64
65
66
67

68
69
70

Fixings, 1993.

72 to 80

Emergencyelectricalservices, 1993.

Abatement of electricalinterference, 1993.

Bedhead services, 1994.

Health building engineeringinstallations:

commissioningand associated activities, 1978.

18

Facsimile telegraphy: possible applicationsin

DGHst
Facsimile telegraphy:the transmission

19

of

pathology reportswithin a hospitala case

studyt
2020
2021

Electrical safetycode for lowvoltage systems,

1993.
Electrical safetycode for high voltage systems,

2022
2023

1993, 1994.
Medical gas pipelinesystems, 1994.
Access and accommodationforengineering
services*

2025
26

Ventilation in healthcarepremises, 1994.

Commissioningof oil, gas and dual fired boilers:
with noteson design,operation and
maintenancet

28 to 39
2040

to49

2050

to 53

2055

The control of Iegionellae in healthcare

premisesa code of practice, 1993.
Risk assessment in the NHS estate, 1994.

Telecommunications(telephone exchanges),
1994.

28

Usermanual, 1993.
Windows, 1989.
Partitions,1989.
Internalglazing*
Internaldoorsets, 1989.
Ironmongeryt

Materials managementmodular system*

Firecode

2014
2015

51

54.1
55
56
57
58
59

71

12
13

41

Component DataBase (HTMs 54to70)

81
81

Firecode: fire precautionsin new hospitals*

82
83

Supp 11993.
Firecode: alarm and detection systems, 1989.
Fire safety in healthcarepremises: generalfire

85
86

precautions,1994.
Firecode: fire precautionsin existing hospitals, 1994.
Firecode: fire risk assessment in existing hospitals,

87
88

1994.
Firecode: textiles and furniture, 1993.
Fire safetyin health care premises: guide to fire
precautionsin NHS housing in the community for
mentally handicapped/illpeople, 1986.

New HTMs in preparation

2024
2030

Lifts
Washers

for sterileproduction

HealthTechnicalMemorandapublished by HMSO can be

purchasedfrom HMSO bookshopsin London(post orders to
P0 Box 276, SW8 5D1), Edinburgh, Belfast, Manchester,
Birminghamand Bristol, orthroughgoodbooksellers.
HMSOprovide a copy service for publicationswhich are out
of print; and a standingorderservice.
Enquiries about HealthTechnical Memoranda(butnot
orders)should be addressed to: NHS Estates, Departmentof

Health, Marketing Unit, 1 Trevelyan Square,BoarLane,

Leeds LS1 6AE.

About NHS Estates

NHSEstates is an Executive Agencyofthe Departmentof

Healthand isinvolvedwith allaspectsofhealth estate
management,developmentand maintenance.The Agency
has a dynamicfundof knowledgewhich ithas acquired
during 30yearsofworkingin the field. Usingthis
knowledgeNHSEstates hasdevelopedproducts which are
unique in rangeand depth. These aredescribedbelow. NHS
Estates also makes itsexperienceavailabletothe field

HealthGuidanceNotes an occasional series of

publicationswhich respondto changesin Department of
Health policyor reflect changing NHS operational
management.Each dealswith a specific topicand is
complementarytoa related HTM. HMSO
Firecode for policy, technical guidanceand specialist
aspects

offire precautions.HMSO

throughitsconsultancyservices.
Enquiries about NHS Estates should be addressed to:
NHS Estates, Marketing Unit, Department of Health,
1 Trevelyan Square, BoarLane, Leeds LS1 6AEW.

Capitallnvestmentment ManualDatabase software

support for managing thecapital programme. Compatible
with the Capital InvestmentManual. NHSEstates
Model EngineeringSpecifications comprehensive

Telephone0113 254 7000.

Some other NHS Estates products

ActivityDataBase a computerisedsystem for defining
the activitieswhich haveto be accommodatedin spaces
within health buildings.NHSEstates
Design Guidescomplementaryto Health BuildingNotes,
Design Guidesprovide advicefor plannersand designers
about subjects not appropriatetothe Health BuildingNotes
series. HMSO

Estatecode user manual for managing a health estate.

Includesa recommendedmethodologyfor property
appraisal and provides a basisfor integration of the estate
intocorporate business planning. HMSO
Concode outlines proven methods of selectingcontacts
and commissioningconsultants.Reflects officialpolicy on
contract procedures.HMSO

Works Information ManagementSystem a

computerisedinformation systemfor estate management
tasks, enablingtangible assets to be put into thecontext of

adviceused in briefing consultants, contractorsand

suppliersofhealthcareengineeringservices to meet
Departmentalpolicy and best practiceguidance.
NHSEstates

Quarterly Briefing givesa regularoverview on the

construction industry and an outlook on howthis may
affectbuilding projectsin thehealth sector,in particularthe
impact on business prices. Also provides information on
new and revised cost allowancesfor health buildings.
Published fourtimes ayear; availableon subscriptiondirect
from NHS Estates. NHSEstates
Itemsnoted "HMSO" can be purchasedfromHMSO
Bookshops in London (post orders to P0 Box 276, SW8
5DT), Edinburgh,Belfast, Manchester,Birminghamand
Bristol

orthroughgoodbooksellers.

NHS Estates consultancyservices

Designed to meet a range of needs fromadviceon the
oversightof estates managementfunctions to a much fuller

collaborationfor particularlyinnovativeorexemplary
projects.

servicing requirements.NHSEstates

Health Building Notesadvicefor project teams

procuring new buildingsand adapting or extending existing

Enquiries should be addressed

Service (address asabove).

to: NHS Estates Consultancy

buildings.HMSO

Dd300496

Printed in the unitedKingdom forHMSO

C15 3/95 3400/4 65536 315791 07/32192

29

Departmentof Health
Scottish Office

Welsh Office
DepartmentofHealth
and Social Services
Northern Ireland

HealthTechnical Memorandum(HIM) 2027provides

recommendations,adviceand guidance onthe design,
installation and maintenanceofhotand cold water
distribution systems in healthcarepremises. Itis
applicableto newand existing sites,and isforuseat
various stages duringthe inception,design,
upgrading, refurbishment,extensionand
maintenanceofa building.

II\1()
Publishedby HMSOand availablefrom:

HMSOPublications Centre
(Mail, faxand telephone orders only)
P0 Box276, London 5W8 5DT
Telephoneorders 0171 873 9090
Generalenquiries0171 8730011
(queuingsysteminoperation forboth numbers)
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andthrough goodbooksellers

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ISBN 0-11-322179-7