Transforming Harrogate and District NHS Foundation Trust with RO Unit Resilience: ‘A Breath of Fresh Air’

In the centralised decontamination facility, Clare Illingworth, head of medical devices and sterile services, explains: “Previously we had a cold reverse osmosis water treatment system feeding the endoscope washer-disinfectors and a hot RO unit feeding the sterile service washer-disinfectors and autoclaves which have steam generators. The old RO plant, which was nearing the end of its lifespan, was frequently breaking down and there were times when we were having to reduce our service to theatres.

“Originally, we were only replacing the sterile services’ washers which were about 18-years old. But given the opportunity and the fact that we took the service off-site for eight weeks while the work was done, we decided to replace one of the RO systems and provide resilience to the existing system.

“We worked off-site at B Braun Medical’s centralised facility in Pudsey. We’d done the same in 2017 when the department was refurbished – but not the equipment – and it worked very well.”

Clare Illingworth, left, head of medical devices and sterile services, and lead governor Harrogate and District Hospital NHS Foundation Trust, with Elaine Stanton, sterile services manger.

Clare and Stephen Worwood, the trust’s authorised person (AP) and estates specialist project manager, prepared the specification for the tender. Clare explains: “We specified that the RO equipment needed to be able to cope with the capacity and the demand. We wanted to create our own duplex system. This way, if one system went down, the other RO unit would meet the demand of the whole system. It was about the service aspect too, ensuring operation during maintenance and providing resilience in case of a breakdown.

Assessing lifetime costs and service quality of RO suppliers in the NHS Supply Chain Framework

“Our AE(D), Jonathan Tucker, said that there are multiple RO suppliers on the NHS Supply Chain Framework for decontamination, it wasn’t just about the equipment, the level of service and lifetime costs were also key factors. So, part of the evaluation was contacting my peers within the decontamination sector to ask them about their experiences of the levels of service from the various suppliers. The feedback was very positive for Envirogen.”

“We shortlisted three manufacturers. They were all compliant with the specification, but Envirogen stood out as the most cost competitive over the operational lifetime. In terms of servicing, Envirogen came out on top overall and is on the NHS Supply Chain Maintenance Framework.”

One of the existing, RO units was removed by Envirogen’s team of engineers, who then installed two of the company’s RO systems, including commissioning and taking water samples for validation.

The first is an Envirogen EndoTherm Duo cold RO system with a 200-litre treated water tank feeding four pass-through endoscope washer-disinfectors. The second is a larger EndoTherm Duo XL hot water RO plant with a 500-litre treated hot water tank feeding the sterile services’ four new instrument washers and the existing autoclaves with separate steam generators. The XL model’s 500-litre tank is necessary for sterile services departments as instrument washers have a larger instantaneous water requirement.

The scheme comprises an Envirogen EndoTherm Duo cold RO system and an EndoTherm Duo XL hot RO system.

Duplex RO systems: reinforcing reliability in business continuity planning (BCM)

The remaining old RO unit and the new Envirogen RO system are currently running in tandem, with each system feeding 50% of the capacity. In case one system fails, the other is capable of providing the additional 50%. In fact, the Envirogen equipment has already had to compensate for the older system’s deficiencies on several occasions since its installation, due to ongoing reliability issues with the older unit.

“When we review our business continuity plans, we will be challenged on our scenario-based planning,” says Clare. “This new installation has ticked a massive box in our continuity. It’s highly unlikely that both RO systems would fail at the same time. The only reason we would now need to move off-site is if there was no water getting into the building, which would bring a more challenging problem for the trust than whether sterile services can operate.”

Streamlining service with advanced remote monitoring and management system

With the service aspect being such an important element in the assessment, has Envirogen’s performance met the expectations which colleagues described?

“Whilst the service contract is still being finalised, Envirogen have kept us up and running with no questions asked and no delays,” says Clare. “They have been incredibly attentive and responsive.

“The system’s remote diagnostic facility has been fantastic. It’s enabled the Envirogen service team to be on the end of the phone and talk to our estates engineers and sort out any issues.

“For example, when we encountered an issue with an alarm, the Envirogen team immediately dialled into the remote diagnostic system. They guided our engineer through the problem and continued to monitor the situation, providing us with additional assurance.

“There were also potential issues that our own hospital engineers were not able to understand, but Sam has resolved them and explained the solution. For example, some machines had incorrect outlet terminations, which was due to an error with the hospital specification, but Envirogen dealt with that without question.”

Clare adds: “Sam’s been great. I can’t fault him at all. He always answers his calls. His follow-up is excellent. He always checks that everything is OK afterwards. Sam is very professional and understands the impact of any issues on the service we provide to ensure we can provide the best service outcomes for patients.

“The Envirogen engineers have been very good,” says Clare. “When they came to install the stainless-steel work, we hardly knew they were here. They were competent and capable, and there was minimal disruption. The only indication I had of their work was when it was completed – it was seamless. From beginning to end, everything was done smoothly.”

Equally full of praise for Envirogen, Elaine Stanton, sterile services manager, says: “They do what they say. They are here when they say they will be – never any excuses. Envirogen are a breath of fresh air. The installation guys were seamless. Sam’s turned our RO service around completely. It’s wonderful how they respond when you pick up the phone. It’s a game-changer.”

Clare says: “We no longer worry what we might do if an RO plant goes down. We have resilience built in.

“Not only do we now have peace of mind, we’ve included scalability. We increased our water capacity by 75% in sterile services and still have capacity to add another 25% in sterile services, plus another autoclave, and 30% in endoscopy.

“Envirogen’s RO systems have the option of a larger water tank which is a major benefit. The other suppliers were offering two sets of smaller tanks.”

Very involved with the specification and responsible for overseeing the installation, Stephen Worwood, the trust’s AP decontamination and estates project manager, explains:

“We wanted to ensure that with the system we have in place we could have at least 50% of the equipment working and fully functional at all times – even during service and maintenance – for uninterrupted supply. We wanted interchangeability to be able to switch between the systems easily.”

“Future-proofing is built in. We will be able to add two extra pass-through cabinet washers in endoscopy and an additional autoclave in sterile services. I found that Envirogen were incredibly helpful, extremely friendly and always willing to go the extra mile. The equipment is highly efficient and extremely reliable. It’s a very compact arrangement with a self-contained bund.”

“Their installation team was very professional. It was a seamless service,” adds Stephen. “As AP, I signed-off everything on the commissioning of the new equipment and that went to the relevant AE(D)s for their approval. I like Envirogen’s plant a lot. The visual human interface (HMI) display is very good. It makes the system easy to navigate.”

In the plantroom, demonstrating the ease of using the EndoTherm Duo’s informative touchscreen, Kevin Clarke, maintenance technician, competent person (CP) and authorised person (AP) decontamination, says: “The screen is so user friendly. You can go through the options and quickly locate exactly what you want to see.

“We’ve had no reliability issues with Envirogen, absolutely none. It’s a very compact unit. The Envirogen team are great – very helpful.”

Describing the scheme, Sam Blakemore, Envirogen’s healthcare area sales manager – north, says: “We supply a range of EndoTherm reverse osmosis systems to meet every demand. In this scheme the sterile services element of the installation utilises the latest addition to the EndoTherm family, the Duo XL which has a 500-litre treated water tank to provide hot RO water for up to five instrument washers and five autoclaves, making it ideal for a mid-sized department.

“The endoscopy element has the standard EndoTherm Duo RO unit to provide purified water to four endoscope washers-disinfectors. The system was purchased through NHS Supply Chain which has the added benefit of Envirogen’s unique 25-month warranty.”

Future-proofed and resilient water purification system: delivered on time and within budget

Sam explains: “The installations were executed by Envirogen’s project management team, liaising with the trust to reduce disruption, and brought in on time and on budget. Both installations underwent water analysis and were handed over to the client after meeting the relevant HTM standards.

“The complete installation of both duplex reverse osmosis water purification plants will be under an Envirogen PureCare service and maintenance contract utilising our regional service engineer teams.”

The modular and upgradeable EndoTherm range can be set to operate at ambient or elevated temperatures (user adjustable) with automatic thermal sanitisation takes place out of hours. A combination of reverse osmosis technology, ultra-violet disinfection, sub-micron filtration and constant recirculation work together to maintain maximum water quality at a range of dispense rates matched to single or multiple decontamination equipment needs. To enable fast installation and the optimum use of available space, each system is based on four prefabricated modules.

Clare adds: “With Envirogen, we now have a resilient, future-proof RO system, that was cost competitive and has proven to have service back-up that is attentive and responsive.”