Hydrotherapy Risk Management

Original Editor - Sue Wagstaff.

Top Contributors - Naomi O'Reilly  

Summary of Hazards

Working in water is potentially hazardous for both patients and physiotherapy staff.  Hazards include:

  • Drowning
  • Heat Exhaustion
  • Fall
  • Slip
  • Infection
  • Pool Entry and Egress
  • Skin Irritation
  • Droplet Infections e.g.Legionella
  • Electric Shock.
  • Otitis externa

Clinical Contra-indications/Precautions

Persons who might be harmed:

  • Patient
  • Carer
  • Physiotherapy Staff
  • Domestic Staff
  • Estates Staff
  • Trust

Controls

  • To prevent drowning- unauthorised access to the hydrotherapy pool should not permitted, non physiotherapy staff must be escorted into the area. There should be a lock on the main door for entry and the area is alarmed during ‘out of hours’ times. Patients admitted for treatment should be under supervision both whilst in the pool and before and after pool sessions. Throughout a treatment session the patient should be directly supervised by an experienced Physiotherapist (2 years qualified with a hydrotherapy certificate) or a Physiotherapy Assistant who is supervised by an experienced Physiotherapist. Ideally the Physiotherapy assistant should also hold a hydrotherapy certificate.
  • To prevent heat exhaustion –this may affect patient, carers or physiotherapy staff. There should be strict control of the environment, careful monitoring of a participants fitness and careful pacing of activity all contribute to controlling this problem. The pool water temperature should be thermostatically controlled and monitored, the temperature should not exceed 35.5C and a maximum relative humidity of 55% is maintained whilst the department should be in use. The duration of treatment should be limited for all patients with a maximum limit of 30minutes. Members of staff must not exceed 1.5hours in a session and in addition time should then be allowed for changing, rest and recovery
  • To prevent falls/slips the pool surround should be maintained as dry as possible; staff and patients should wear rubber grooved soled shoes and the floor tiling is designed to reduce the chance of slipping. Patients should be supervised to and from the pool area by one of the staff on duty.
  • To control Pool Entry and Egress – Assessment of a patient’s ability to use the steps into the pool should be made by the physiotherapist in conjunction with the patient. A sitting hoist or stretcher should be available to assist entry and egress. There is a written procedure detailing actions during emergency evacuations and these are practised regularly by all staff that uses the pool. Emergency call system can be activated both from within the pool and outside it.
  • To prevent skin irritation – the pH of the pool should be controlled to minimise eye and skin irritation. The pH should be maintained between 7.2 – 7.8 to ensure effective disinfection and to avoid corrosive damage and the water are constantly filtered.
  • To reduce the susceptibility to Infections – thorough cleaning of the poolside and wearing individualised footwear around the pool reduces the chance of foot infection like Athletes Foot and any person with Veruccas should be asked to wear foot protection in the pool. Good water quality helps prevent the build up of Ps. Aeruginosa, Crptosporidium, Escherichia coli, aided by regular microbiological testing of the water (2X week) and advice and monitoring by a Consultant microbiologist. (Recommendations are in Appendix1.)
  • Droplet infection – should be controlled by the daily cleaning regime and by the Estates Legionella procedures.
  • Electric Shock – The treatment area should be treated as a bathroom with appropriate switching for lights and covered plug sockets to be used by the cleaners. Clinical Contra-indications – a master list should be available to all Physiotherapists when deciding on a patient’s suitability for hydrotherapy.

Risk Management Plan

The following should be included in any risk management plan:

  • Undertake an assessment on all patients using the hydrotherapy pool. This must be included in their clinical record. A standard proforma has been devised on which to record all essential data.
  • Monitoring those people who use the entrance and exit to the hydrotherapy dept. and supervision of all non physiotherapy staff at all times. Ensuring that the digital entrance lock functions.
  • Monitoring of environmental controls and correcting any deviances from normative values. Maintaining a written record daily of the room and pool water temperature and the room humidity and water Ph. Contacting the Estates dept. to correct deviations.
  • Ensure staff and patients wear suitable footwear and the poolside area is maintained a dry as possible. Ensure that no-one runs or plays around the pool area.
  • Induction of all new users of the hydrotherapy facility and regular training updates of evacuation procedures, resuscitation processes, fire and manual handling assessments of each individual patient. Ensure clinical contra indications are enforced.
  • Monitor water quality data provided by the Estates Dept. Take water samples for bacteriological screening on a weekly basis or following a hygiene incident in the pool. Evacuate the pool if the water is fouled and follow the disinfection procedures, as detailed in the evacuation procedure.
  • Ensure the Estates Dept. alert the clinical staff when the water quality reading is unsafe by telephoning the team leader or deputy and by leaving a message in the pool office.
  • Monitor cleaning regime with the Domestic Supervisors. Ensure staff and patients shower before entering the pool. Encourage staff and patients to use the toilet before entering the pool. Check patients for foot infections and provide protective footwear.
  • All incidents reported from the hydrotherapy dept. will be investigated initially by the team leader and reported to the head of dept. An action plan will be developed as necessary.


Recent Related Research (from Pubmed)

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References

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