Letterkenny University Hospital (LUH) is a 302-bed teaching hospital in County Donegal. In addition to providing a wide range of clinical and non-clinical support services, the facility holds an important position in the field of medical education – being linked with three major universities.

Until recently in order to cater for its consumption of purified water, the hospital had four different water treatment systems feeding four different departments. In 2021, LUH was allocated a budget through the National Equipment Replacement Program (NERP) to replace one of its water treatment systems, in that case for its Central Sterile Supply Department (CSSD). After a risk analysis, the advanced age and potential lack of resilience in the historic plants were identified. A project was advanced to enable the design of a single plant that would combine three of the historical plants – one system to feed multiple departments – a first of its kind in Ireland.

Project snapshot

The HSE team, Mark Grumley – Chief Assistant Technical Services Officer (CATSO) for HSE Estates North West and Tony Curley – Senior Clinical Engineering Technician for LUH worked cooperatively to design a unique water treatment system to provide three departments with purified water – the CSSD, the Endoscopy Reprocessing Department and the Day Service Department. It was recognised that with an ageing population in the area served by LUH there was a real need to face the growing demand for patient care and surgeries. This meant that the new system also had to cater for future upgrades.

Manepa Medical won the tender submission and delivered a solution to these key requirements from Envirogen Group, the leader in the field and a key partner for Manepa. Working closely together the new innovative water plant was installed, commissioned, and validated by Manepa.

What we delivered

Manepa Medical delivered a duplex modular reverse osmosis (RO) system – called Endotherm Modular – manufactured and supplied by Envirogen Group. The system has a nominal 2 x 2,400 litres per hour flow rate, configured as 2 x 910 litres per hour, in twin pass – duty/standby.

In more detail, the unit comprises a 1000L raw water booster tank, duplex booster pumps and duplex carbo softeners, feeding pre-treated water to the duplex RO unit. The RO permeate water is then fed to two independent 500L stainless steel tanks and distributed via a duplex recirculation loop skid (with a flow rate of 120 litres per min for each pump). One, the “hot loop” for 65°C water serving the CSSD and the Endoscopy Reprocessing Department (ERD), the other for ambient temperature water also serving the ERD and Day Service Department. Each department is provided with alarm status indicators. Finally, the RO system is complete with 24/7 remote monitoring and diagnostics. 

The design of the system was adapted to meet the water requirements and available room space as specified by the HSE team. Additionally, Hugh O’Connor Principal Clinical Engineer from AEDH LTD (Authorised Engineer Decontamination Hospitals) played an important role in assessing the project’s feasibility and approving the installation and commissioning of the system.

In terms of implementation, the system was installed and connected to each department on an incremental basis – meaning there were no interruptions of service for LUH. It is also worth noting that the system was installed, brought online, commissioned, and validated in line with all current ISO requirements. The project was estimated to take approximately six months from the tendering process to installation and final sign-off, and the projected timeline was achieved successfully.

The new water treatment system was installed in an existing unused room at Letterkenny University Hospital

Operational goals

Prior to the project, LUH had planned for all RO plants to be replaced within the next two to three years. Each of its four plants had a single point of failure and if any part of the system failed, the delivery of water was completely stopped and required immediate remedial work. The HSE team explained that due to the geographic location of LUH, then “the service response times were challenging”, leading to a significant loss of service to the department and LUH. In addition, in-house experience with common faults and breakdowns on previous RO systems was limited and presented a challenge for the hospital. Lastly, it was recognised that having multiple RO plants meant multiple maintenance and validation contracts, each with their own costs.

These challenges illustrate the importance of water systems in patient care and hospital operations, as highlighted by Hugh O’Connor, Authorised Engineer who advises 26 hospitals in the HSE and voluntary hospital network: “Clean water systems for clinical application are an invaluable asset”. Therefore for LUH having a resilient system was fundamental as was the critical need to cater for a 25% capacity increase to accommodate extra endoscopy washers requiring RO water.

Outcomes

On the 10th of February 2022 Manepa Medical handed over the new RO plant – the first obvious benefit was the provision of a simplified and more efficient system. As a result, the washer-disinfectors in the CSSD had a quicker drying time, which in turn increased CSSD throughput.

Improved System resilience was the second major benefit delivered by the new installation. For example, the “hot loop” has removed the requirement for an external Treated Water Boilers connected to the Endoscopy Washers and thereby removing a single point of failure from the Endoscopy department.

The simplification of contract management has also meant that Manepa Medical is the unique provider for the maintenance of the one RO plant and is the single point of contact.

Project team

Involved in this project are Mel Hasanovic, Contracts Manager at Manepa Medical, Mark Grumley, Chief Assistant Technical Services Officer (CATSO) for HSE Estates North West, Tony Curley, Senior Clinical Engineering Technician at LUH and Hugh O’Connor MSC BSC C Eng, Authorised Engineer/Principal Clinical Engineer at AEDH LTD.

About Letterkenny University Hospital

Letterkenny University Hospital (LUH) is an acute general and maternity Hospital, which forms an integral part of the Health Service Executive North West Region. The Hospital aims to deliver a patient-centred, quality-driven focused service and provides a wide range of diagnostic and support services. LUH is a teaching hospital with links to the National University of Ireland Galway, the Royal College of Surgeons, and the Letterkenny Institute of Technology.

About Manepa Medical

Manepa Medical has been supplying and servicing decontamination equipment for over 50 years. In 2018, the company expanded its offerings with a water treatment division backed by a partnership with Envirogen and an experienced team. Since then, the company has a proven track record of successful and innovative water plants installed across Ireland for the healthcare industry. Manepa offers turnkey solutions, from design to installation, training, and validation.

About AEDH LTD

Hugh O’Connor MSC BSC C Eng is an Authorised Engineer providing specialist technical advice, guidance and support to healthcare organisations to meet the regulatory and statutory requirements. Hugh O’Connor is also an IHEEM (Institute of Healthcare Engineering and Estate Management) Expert member and lecturer in Technical University Dublin and designed a validated course for Decontamination of Medical devices aimed at health professionals and technical support staff.