A corrective action ensures an immediate response to a failure in a control measure.
For example, if an operational monitoring result indicates the disinfection residual is not within the set critical limit, as per the water risk management plan (WRMP) for the facility, a corrective action should be triggered to address the disinfection residual issue.
This is not the response to results from verification monitoring, e.g. detection of Legionella bacteria in the water system. These responses are dealt with elsewhere.
Key components of corrective actions
Details of corrective actions should be documented in your WRMP and should consider the following.
Identify the people who need to be notified when a corrective action is triggered.
- Will the failure impact on services to patients?
- Will kitchen and laundry operations be affected?
- Will any medical equipment be affected?
- Is there a need to call outside maintenance contractors (e.g. plumbers)?
- Can the water supply be continued or should it be restricted?
- Is it impacting a high risk area within the facility?
- Can the failure be fixed with increased flushing?
- Should patients be moved (for example, high risk patients)?
- Should alternative drinking water be provided?
- Does a part of the system need emergency repairs or maintenance?
- What is the history of operational monitoring at the outlet? For example is it frequently close to the critical limit and therefore is a better control or more regular monitoring required?
- Is water use exceeding the capacity of the system to stay within the critical limits (e.g. is high use of hot water preventing the water heater from reaching a sufficiently high temperature to ensure adequate Legionella control)?
- Have planned preventative maintenance records been checked?
- Do alternative or additional control measures need to be considered?
- Should monitoring be increased for a period of time to ensure the corrective actions were effective?
- Should more frequent monitoring be implemented permanently?
- Should there be amendments to the WRMP?
- Should staff education or training be increased?
Other supporting measures
Facility management should consider ensuring that spare parts for critical components of the water infrastructure system are in stock.
- National enHealth guidelines for Legionella control (PDF, 577KB) section 3.2.1 (page 26 to 27)
- National risk management plan template (DOC, 164KB) section 3.2, Table 7 (pages 9 to 10)