Hydrotherapy, Policy, Procedures and Guidance. Ty Gwyn School and Cardiff and Vale UHB

Transcription

1 Hydrotherapy, Policy, Procedures and Guidance Ty Gwyn School and Cardiff and Vale UHB UHB Reference No: LEA Reference Number Issued by Policy Manager Version No: 1 Previous Trust / LHB Ref No: LEA Ref No : 0 Documents to read alongside this Policy, Procedure etc Cardiff and Vale UHB Risk Management Policy and Strategic Framework CSP 2006 Guidance on Good Practice in Hydrotherapy CSP 2000 Code of Conduct CSP 2002 Hazards in Hydrotherapy PHLS 1999 Hygiene for Hydrotherapy Pools Public Health Laboratory Services, London Pool Water Treatment Advisory Group 1999 Managing health and safety in swimming pools, HSE Pool manufacturers maintenance procedures for main pool and splash pool Classification of document: Clinical Practice Area for Circulation: Paediatric Therapies / Child Health Directorate / UHB wide, Ty Gwyn School / Cardiff LEA Author: Executive Lead: Group Consulted Via/ Committee: Children and Young Peoples Physiotherapy Service Ty Gwyn School Management Team Katie Norton, Executive Lead Dr Dirk Wilson, Divisional Director Kevin Tansley, Headmaster Ty Gwyn School Child Health Directorate Clinical Governance: Cardiff and Vale UHB Ty Gwyn School Management Team Procedures and Guidance Page 1 of 26 Reference No:

2 Ratified by: Divisional Quality and Safety: Cardiff and Vale Cardiff LEA clinical governance Date Published: Date becomes live Version Number Date of Review 1 April 2016 Reviewer Name Mr M Thomas Mr N Roberts Mr S Coplin Completed Action Approved By Governing Body Date Approved New Review Date Disclaimer When using this document please ensure that the version you are using is the most up to date either by checking on the UHB database for any new versions. If the review date has passed please contact the author. OUT OF DATE POLICY DOCUMENTS MUST NOT BE RELIED ON Procedures and Guidance Page 2 of 26 Reference No:

3 Contents Page 1. Background 4 2. Objectives 4 3. General 4 4. Normal Operating Procedures 5 5. Hygiene 8 6. Health and Safety 8 7. Medical Information 9 8. Contra-indications 9 9. Emergency Action Plan Training References Appendices Appendix A - Normal Working Practise 11 Appendix B - Emergency Procedures 12 Appendix C Risk Assessments 15 Appendix D- Consent Form 16 Appendix E - Skin Care Guidance 17 Appendix F Procedure in the Event of Fouling Pool 18 Appendix G - Hydrotherapy Pool Inspection Audit Tool 19 Appendix H Proposed Maintenance Schedule (LEA) 22 Appendix I - Staff Competency checklist 25 Appendix J - Individual Risk Assessment/Aid Memoir Procedures and Guidance Page 3 of 26 Reference No:

4 1. Background This policy has been developed in joint collaboration between Cardiff and Vale UHB, Paediatric Therapy services and Cardiff LEA, Ty Gwyn School, in an effort to standardise management of hydrotherapy provision within the Child Health Directorate, Cardiff and Vale UHB and in particular at the new Ty Gwyn facility The physical structure of hydrotherapy pools, their high water and air temperatures and intermittently intensive use by diverse groups of patients and staff, together produce potentially hazardous conditions. Therefore there is a need for clear-cut control and monitoring and for effective working relationships between physiotherapists, microbiologists and engineers (Public Health Laboratory Services 1999) The standardisation of policies and procedures for hydrotherapy pool management will assist the UHB/LEA in meeting the required standards for this clinical area and support the UHB /LEA governance agendas. All users must be aware that working in water is potentially hazardous for both pupils and physiotherapists (Reference: Guidance on Good Practice in Hydrotherapy CSP 2006). This is to ensure that all appropriate precautions are put in place in order to minimise risks to both users and those assisting them. 2. Objectives The broad aim of this policy is to standardise the way that Hydrotherapy provision is managed within the UHB, at the new Hydrotherapy Pool in Ty Gwyn School and to provide staff with appropriate information. This policy will apply to use of the hydrotherapy pool during the following times: During school term time During the school holidays. After school hours 3.30 pm to 5.00 pm The use of the hydrotherapy pool outside normal school hours will be dependant on any additional school insurance requirements being met. 3. General 3.1 The Local Education Authority will ensure the hydrotherapy pool at Ty Gwyn School, and its associated facilities are suitable for use and do not present unacceptable risks to the Health and Safety of any user. The pool and its associated facilities will be used in accordance with Advice and Guidance from the Local Education Authority. 3.2 The Local Education Authority is responsible for the overall management of the hydrotherapy pool at Ty Gwyn School. All matters relating to the pool must be referred to the School Maintenance Team and Lifeguard 3.3 No person will enter the water unless the Lifeguard is present. 3.4 Cardiff and Vale University Health Board staff will assume responsibility for patients and for the enforcement of regulations when using the Hydrotherapy Pool area for therapy Risk assessments must be adhered to at all times Appendix C 3.5 In an emergency the alarm must be raised immediately and the emergency evacuation policy must be adhered to.- Appendix B 3.6 Each pupil/patient using the hydrotherapy pool must have written consent from the parent/guardian before using the pool - Appendix D Procedures and Guidance Page 4 of 26 Reference No:

5 3.7 Pupils/patients not participating in hydrotherapy sessions must not be present on the pool side. 3.8 It is the responsibility of the LEA Lifeguard / LEA Maintenance Team to carry out pool testing (e.g. chlorine and acidity levels); the minimum requirement is three times daily. A written record / chart of these pool parameters must then be visible for all pool users to refer to. - Appendix E ( Skin Care Guidance) 3.9 Equipment in the Hydrotherapy Area must be used only for its proper purpose. Any damage or defects must be reported to the LEA Maintenance Team and Lifeguard No responsibility is taken by The Local Education Authority or Cardiff and Vale University Health Board for any personal property left in the pool or changing rooms The pool and changing areas must be left in a clean condition after each session. Towels and swimming costumes must not be left drying in the pool area All after school clubs have access to Normal operation practice (NOPs) and Emergency Action Plan (EAPs) 4. Normal operating Procedures 4.1 The pool operator is the Head teacher of Ty Gwyn School, who along with the LEA is responsible for the overall management of the pool. The pool operator is responsible for ensuring that the pool and associated facilities to do not present unacceptable risks to Health and Safety of any user. The pool manager is the Phil Pietzka who is the Estates Manager and who has responsibility for the day to day management of the pool. The pool maintenance team consists of Phil Pietzka (Estates Manager) Mark Davies (Teaching Assistant), Sarah Perry (Teaching Assistant), The maintenance team have a joint responsibility for the maintenance and record keeping of the pool including daily checks of water temperature, PH, Chlorine levels, water clarity. The minimum requirement is 6 times daily (see appendix H) Pool Uses In day to day teaching and learning, the use of the hydrotherapy and splash pools serves a number of purposes: An environment for physiotherapy led hydrotherapy An environment for teacher/class team led hydrotherapy where staff implement a physiotherapy agreed programme An environment to meet specific PE subject focused objectives An environment to meet specific sensory focused objectives An environment to meet specific communication focused objectives An environment for relaxation An environment for leisure activities In addition, the pool may be rented by outside agencies and subsequently, their use may not appear on the above list. They are however bound by the pool s normal operating procedure and rules. General Rules The following are general rules and students and staff should try to adhere to them: No running Procedures and Guidance Page 5 of 26 Reference No:

6 No pushing/throwing No diving No bombing No fighting Only authorised pupils allowed in poolside No standing on floats Pupils are not allowed to wait for prolonged periods on the poolside No smoking No glass or breakable china in the pool or changing areas Pool Dimensions The pool measures 9 m x 4 m and has a shallow end depth of 0.8m and a deep end depth of 1.2 m. Entrance to the main pool hall is via 2 points: Off the main corridor From the changing rooms The plan of the room is shown opposite. Safety Equipment in the Pool Both the swimming pool and changing room areas have a first aid kit. There is a telephone in the pool hall equipped with a panic button. To dial emergency services, the user must dial 9 for an outside line then 999. In addition both the changing rooms and pool hall are equipped with a medical assistance (nurse) button. On the poolside: Deluxe life Buoys Over head hoisting system and Liko slings Reach poles Rescue Board Life hook and handle Pool Access and maximum numbers of bathers A qualified lifeguard must be present at all times when people are in the pool. In addition, there are times when an additional adult supporting the lifeguard from the pool side is needed. This person is named a spotter. The spotter is needed when there are 5 or more pupils in the pool or when an individual risk assessment calls for one. Students diagnosed with Special Educational Needs (SEN) and children who are not competent swimmers must have at least 1:1 adult support in the pool. In some cases, this ratio may rise depending on individual risk assessments Competent swimming children under 16 years old and Children not deemed to have SEN can use the pool at an adult: pupil ratio of 1:2. In addition, a lifeguard and spotter must be present. Procedures and Guidance Page 6 of 26 Reference No:

7 Adults and competent swimming children over the age of 16 are permitted to use the pool without assistance in the pool. However, a life guard and spotter must be present on the pool side The pool has a surface area of 45m2 (45 square metres). The school uses the recommended formula of 3m2 per person. Therefore the maximum number of people allowed in the pool at any one time is 15. Pool users must adhere to the following limits. Group dynamics Students with SEN Children under the age of 16 without SEN Competent swimmers over 16 years of age Hoisting Equipment Maximum Numbers 7 pupils, 7 adults + lifeguard + spotter 10 pupils, 5 adults + lifeguard + spotter 15 + lifeguard + spotter Only 2 children can be hoisted into the pool at any one time. Lifeguard s Duties and Responsibilities The designated school lifeguards are Leon Gorman and Daniel Cowhey. A lifeguard must be present for every pool session and no body is permitted to use the pool without a lifeguard being present. A lifeguard must be in possession of an LEA accepted lifeguarding qualification e.g. NPLQ. Desirable Characteristics of a lifeguard Be physically fit, have good vision and hearing, be mentally alert and self-disciplined Be strong, able and confident in the water Be in possession of a recognised qualification Committed to ongoing training and be provided with regular training opportunities Key Tasks of the on Duty Lifeguard The key tasks of the on duty lifeguard are to: Anticipate problems and potential emergencies and act accordingly Enforce the rules e.g. make sure users are showering before and after use In collaboration with the session leader, control the behaviour of the swimmers and staff Give immediate First Aid in the event of injury (if qualified) Initiate emergency action (e.g. rescue sequence) Initiate pool evacuation procedures Communicate with swimmers Record any incidents Check saving aids are stored correctly and fit for purpose Be aware of other members of staff i.e. who they are, where they are and who they are with Be aware of the session leader and keep in constant communication with this person Ensure correct safety signs are in place and visible Remain alert at all times if the lifeguard becomes tired, they must make arrangements to evacuate the pool Be in possession of and use a whistle to raise the alarm Never turn their back on the pool Ensure that emergency evacuation procedures are practiced each term Must be sat on the pool chair tower (before class are in the pool) Wear appropriate kit to be easily identifiable to all staff, pupils and visitors. Check pool alarms at 8.45 before pool opens Attends staff training on a monthly basis ( 20 hours over two years ) If training is missed the lifeguard will complete competency test Procedures and Guidance Page 7 of 26 Reference No:

8 If returning from long-term sickness the lifeguard will complete full competency test before resuming duties. Maintenance Tasks of the Duty Lifeguard At the each day, the lifeguard must ensure that: The changing areas and poolside are clean and tidy and free from excess water The pool is vacuumed and the cover in place The sensory lights and computer systems are turned off Hydrotherapy Pool Maintenance The Local Education Authority Lifeguard and LEA Maintenance Team will be responsible for the management of the plant room and hydrotherapy pool. The Local Education Authority Lifeguard and LEA Maintenance Team will be responsible for the testing and recording of air and water temperatures, Ph and Chlorine levels. The plant room and chemical storage areas must be kept locked and admittance to authorised persons only. The Local Education Authority Cleaning Staff will be responsible for daily cleaning of the pool side changing room areas. 5. Hygiene 5.1 Outdoor shoes must not be worn in the pool area. 5.2 The class teacher or physiotherapist leading any hydrotherapy session shall insist on the correct use of showers, toilet and changing facilities before and after entry to the pool. All users of the pool must shower before entering the water. 5.3 Jewellery should not be worn in the pool. 5.4 All children, when in the pool, must be supervised or supported by a member of staff. 5.5 Suitable swimwear must be worn, no nappies/pads. 5.6 Drinking water is permitted 5.7 No food to be consumed on the poolside 5.8 Chewing gum is strictly prohibited 5.9 Person(s) using the pool must wear appropriate attire. 6. Health and Safety 6.1 Hydrotherapy Pool Inspection Audit Tool to be undertaken at the beginning of each School term Appendix F 6.2 The following information must be available to all staff working in the pool area. Emergency fire evacuation procedure Emergency evacuation procedure Risk assessment of area Risk assessment of manual handling procedures and use of hoist, including procedures in case of hoist failure Generic risk assessments and individual risk assessments where necessary Individual pupil/patient record (PEEPS) Hazard Notices as appropriate e.g. Wet floor Pool entry and exit instructions for staff as appropriate Procedures and Guidance Page 8 of 26 Reference No:

9 Written consent from parent or guardian for all pupils Contraindications Incident and accident reporting procedure Record charts of pool parameters Follow Procedure in event of fouling by organic matter (faeces) Appendix G 6.3 Environmental Considerations Changing rooms must be adequately supervised Hoist must be used for non ambulant children in line with manual handling. Access to drinking water is recommended The temperature must be maintained at degrees. It is advisable for the pool hall side lights to remain on during a hydrotherapy session The pool cover must be in place at the end of every session and the blinds drawn All doors must be closed when pool is not in use. 6.4 User Considerations Children should not be in the pool longer than minutes and therapists no longer than1.5-2 hours without a break; and not more than 3hours in one day A session leader should be designated before each session The lifeguard is entitled to a 15 minute break for every 45 minutes spent on the poolside The Lifeguard and 1 member of either LEA or UHB staff must be on the poolside during a hydrotherapy session This person is named a spotter Volunteers with relevant CRB checks are permitted to be spotters Volunteers are only permitted to undertake manual handling if they have been suitably trained It is the responsibility of the lead therapist or delegated staff member to check with the Lifeguard and the Record Charts of Pool Parameters before using the pool It is advisable that children and staff have a drink and brief rest period after each hydrotherapy session. In the event of a pool user fouling the water, the pool must be evacuated and the Pool Manager and Lifeguard notified. NOP cleaning schedule to be followed. Pregnant staff should have a risk assessment and a pool with a temperature of 35 C and above is to be avoided Specific medical guidelines are to be available for pupils who have medical conditions e.g. epilepsy Physiotherapists should be aware of any change in medical status and discuss any changes observed with the Nursing Team or School Medical Officer /and or Community Paediatrician Staff are to ensure that pupils who have PEG (feeding) tubes or catheters are clamped prior to entering pool Pool pressures to be checked and recorded. 7. Medical Information During a seizure in the water the pupil should be supported safely in the pool while the seizure lasts. In the case of a prolonged seizure the evacuation procedure must be implemented, the school nursing service alerted and if pupil is known to require emergency medicines the nursing staff administer it on arrival in line with care plan 8. Emergency Action Plan Procedures and Guidance Page 9 of 26 Reference No:

10 Emergency Evacuation Procedure must be adhered to and practised once a term - Appendix B In the event of fire evacuate the pool and inform the appropriate emergency services Users will adhere to the requirements and directions of the LEA Lifeguard. 9. Contra-indications and Precautions for using pool Diarrhoea and vomiting Open skin infections Open infected wounds Known infectious diseases Known allergies Scabies Precautions Fear of water Poorly controlled epilepsy Widespread MRSA Poor skin integrity Pregnancy if water temperature is above 35 C Invasive tubes 10. Training All staff must have knowledge of hydrotherapy.training could be provided as follows: Level 1 - Level 2- In House through worked based learning that includes supervised practice with an experienced practitioner. All Cardiff and Vale UHB staff using the hydrotherapy pool must ensure that they are familiar with the H.A.C.P Guidance on Good Practice in Hydrotherapy In House - hosting a recognised Hydrotherapy course or an external recognised hydrotherapy course e.g. Aquaepps 2 day courses 11. References CSP 2006 Guidance on Good Practice in Hydrotherapy CSP 2000 Code of Conduct CSP 2002 Hazards in Hydrotherapy PHLS 1999 Hygiene for Hydrotherapy Pools Public Health Laboratory Services, London Pool Water Treatment Advisory Group 1999 Managing health and safety in swimming pools, HSE Pool manufacturers maintenance procedures for main pool and splash pool Procedures and Guidance Page 10 of 26 Reference No:

11 Appendix A Normal Working Practice (ALL STAFF) This document relates to Ty Gwyn School and outlines normal working practise for a routine hydrotherapy session carried out by all staff at Ty Gwyn School. Prior to Session Collect equipment required prior to entry to Hydrotherapy area e.g. towels, swimsuits, slings etc. On entry to area check: o Pool area clean tidy and ready for use o Lifeguard record chart indicates acceptable parameters o Check hoist is in working order Prepare area for start of session and gather necessary pool equipment/toys Clamp and secure feeding tubes Hoist or transfer pupil/patient on to changing bed Undress pupil/patient and attend to personal cares Shower prior to pool entry (pupils and staff) Lifeguard is positioned in pool tower before session commences. Lifeguard checks clarity of the water. During Session Therapists/class staff enter pool and wait to receive child o At least 1:1 ratio (therapist/class staff: pupil), in the pool (sometimes 2:1) o 1 member of therapy staff to remain poolside at all times Pool side staff hoist child into pool Support child in water while sling is removed Hydrotherapy session commences o Lifeguard (and occasionally a spotter to remain on poolside) Session for each child to last 20 to 30 minutes Lifeguard to receive a 15 minute break for every 45 minutes to 1 hour spent on the poolside After Session Lifeguard checks there is no one left in the pool. (visual check) Pupil/patient hoisted out on to changing bed and assisted with drying and dressing Ensure appliances e.g., orthosis, hearing aids etc replaced Hoisted back into wheelchair Re-attach to feeding pump if necessary Return pupil to class Leave pool area clean and tidy Staff record session in patient record Report any maintenance problems / breakages to Lifeguard / LEA Maintenance Team Lifeguard leaves the pool area clean, dry and tidy. Lifeguard covers the pool. Procedures and Guidance Page 11 of 26 Reference No:

12 Appendix B EMERGENCY EVACUATION OF A CHILD FROM THE HYDROTHERAPY POOL IN A MEDICAL EMERGENCY This section outlines the procedure for the emergency evacuation of a child in the event of a medical emergency such as cardiac arrest, respiratory arrest, prolonged epileptic seizure or if a child becomes extremely unwell for any reason. The procedure will set out the proposed action to be carried out by the Physiotherapy staff or the LEA staff in the pool and pool area during the incident. Persons Involved: All Physiotherapy staff and LEA staff at the school using the hydrotherapy pool will be required to be educated and regularly trained in this procedure. Practising the emergency evacuation procedure should take place each termevery six months; CSP recommendations are that emergency procedures should be practised a minimum of every six months (CSP 2000); the names of those attending emergency evacuation training must be entered on the mandatory training record. New Physiotherapy staff or LEA should attend procedure practise prior to taking part in hydrotherapy sessions where practicable. In the event of a medical emergency occurring within the pool, the following procedure must be followed: Persons involved: All staff working in and around the Hydrotherapy Pool Equipment required: Stretcher Hoist, Suction Unit, Facemask, and Disposable gloves & Aprons Evacuation board 1. The member of staff in the pool alerts the other member of staff present and takes the patient to the poolside close to the hoist. The patient is held in a lying position with their head and pelvis supported. 2. The assistant on the poolside will direct any other patients in the water to leave the pool (if they are able to do so without assistance) or remain in a safe position until staff members are able to assist them. 3. The assistant on the poolside will manoeuvre the flattened stretcher bed into the water. The patient is placed on the stretcher and lifted from the water. 4. Once the patient is on the poolside, the physiotherapist treating the patient or the most senior member of staff present will assess the patient and basic life support will be commenced immediately, in line with resuscitation guidelines. 5. School Nursing staff will be summoned to the area by emergency call button Procedures and Guidance Page 12 of 26 Reference No:

13 6. An ambulance will be summoned by telephoning *(9)999 and the emergency exit on the poolside opened to allow ambulance staff to enter. *indicates 9 must be pressed for an outside line when ringing from poolside. Pool Evacuation duties of the lead person in the water The lead person will normally be the senior physiotherapist present or the most senior member of staff present, who is trained in resuscitation. 1. Prevent submersion and to support the person in a lying position (support head & pelvis). 2. Alert second member of staff to the emergency. 3. Float the patient to the poolside, close to the hoist. 4. Transfer patient to the flattened stretcher bed. 5. Once the patient has been lifted from the pool, to follow resuscitation guidelines. 6. Ensure that the ambulance has been summonsed, if required. 7. Follow resuscitation guidelines until the paramedics arrive. Pool Evacuation duties of second member of staff 1. Remain within earshot whilst patients are in the pool, at all times. 2. If an emergency occurs, call for assistance from other staff in the building and go to the assist with the hoist 3. Direct patients who can leave the pool without assistance, to do so. Instruct those who are unable to leave independently to wait in a safe position. 4. Flatten the stretcher bed and manoeuvre it into the water. 5. Raise the hoist when the patient is in position and bring it onto the poolside. 6. Once the patient has been assessed by the lead person, carry out any instructions given by the lead person (e.g. telephoning 999, assisting other patients to leave the pool). 7. Assist other patients who might be in the pool or changing area and Assist with care of the patient who has collapsed as requested by the lead person Procedures and Guidance Page 13 of 26 Reference No:

14 PROCEDURE FOR THE EMERGENCY EVACUATION OF A CHILD FROM THE HYDROTHERAPY POOL IN THE EVENT OF FIRE Procedure for the Emergency Evacuation of a Child from the Hydrotherapy Pool at Ty Gwyn in the Event of Fire This section outlines the procedure for the emergency evacuation of a child in the event of fire. It should be adhered to in conjunction with school procedure in the event of a fire. The procedure will set out, in step form, the proposed action to be carried out by the Physiotherapy staff and LEA staff in the pool and the pool area present during the incident. Persons Involved: All Physiotherapy staff and LEA staff at the school using the hydrotherapy pool will be required to be educated and regularly practised in this procedure. New Physiotherapy staff and LEA staff should attend procedure practise prior to taking part in hydrotherapy sessions where practicable. Equipment required: Hoist Evacuation Board In the event of fire: Adhere to School Fire Policy / Drill With appropriate assistance from poolside staff and appropriate equipment (hoist / Keifer Board), the patient is transferred out of the pool. Staff and patient to be evacuated from the area / building to a place of safety. Foil heat retaining blankets must be made available for patients who have been in the water. Procedures and Guidance Page 14 of 26 Reference No:

15 Appendix C Risk Assessment November Cardiff and Vale UHB Risk Assessments 2. Ty Gwyn School Risk Assessments Procedures and Guidance Page 15 of 26 Reference No:

16 Appendix D Name of child: I give consent for my child to take part in a hydrotherapy therapy programme. (I have parental responsibility for the above named child) Signed: Name: Date: Name of G.P./Consultant/ Paediatrician: Address of Surgery: Signature: Date: Contra-indications and Precautions for use of hydrotherapy Diarrhoea and vomiting Open skin infections Open infected wounds Known infectious diseases Known allergies Head lice Scabies Precautions Fear of water Poorly controlled epilepsy Widespread MRSA Poor skin integrity Pregnancy if water temperature is above 35 C Invasive tubes Procedures and Guidance Page 16 of 26 Reference No:

17 Appendix E Skin Care Guidance for Hydro therapists The following Guidelines have been developed from CSP Briefing Pack No. 12 Hazards in Hydrotherapy Pools (1999). The CSP recommend that best practice guidelines are followed by all hydro therapists, irrespective of the type of sterilising agent used. 1. Immersion should be limited for all staff to no more than three hours per day (during training programmes however it may be acceptable to exceed this limit for a short period of time). 2. Early reporting of rash symptoms is important. Staff who experience an adverse reaction which they feel is due to immersion in a hydrotherapy pool should report to their line manager and either the UHB Occupational Health Department or the senior leadership team at Ty Gwyn 3. There should be no need to pre-grease the skin prior to entering the pool unless the hydro therapist already has an existing skin condition. A thorough rinse under the shower should be sufficient and this promotes better hygiene, minimises infection risks and minimises the transfer of body oil into the pool water. 4. After a session in the hydrotherapy pool thorough washing should take place and include the following steps. Wash thoroughly using a moisturising agent Dry thoroughly Application of a non-perfumed moisturiser Wear cotton clothing that allows the skin to breathe Procedures and Guidance Page 17 of 26 Reference No:

18 Appendix F Procedure in the Event of Fouling Pool Solid stool The senior member of staff present will decide whether pool users should be asked to leave the water whilst action is taken The stool should be removed with a scoop or net, which should then be disinfected Provided the pool chemistry is correct, no further action should be taken Diarrhoea The most likely cause is bacterial or viral which would be oxidised by the disinfectant Diarrhoea caused by the protozoal parasites, Cryptosporidium or Giardia are more problematic, the infectious stages of these organisms form cysts which are resistant to chlorine Vomit Because vomit will quickly disperse within the pool, the following procedure is also applicable. In the event of a release of diarrhoea or vomit into the pool, the following procedure should be adopted: 1. Clear the pool immediately & advise pool users to shower thoroughly 2. Maintain the disinfectant levels at the top of the range, 4ppm of free chlorine 3. Vacuum and sweep the pool 4. Add a coagulant (aluminium sulphate tablets) to the skimmers 5. Allow the pool to circulate for the remainder of the day (6 Turnovers) 6. Arrange for the filter to be backwashed 7. Close pool until micro biological results 8. Re-open pool when clear results NB. It is recognised that small children on occasions may involuntarily swallow water and consequently regurgitate this during their treatment session. Children should be instructed not to eat within one hour of their hydrotherapy session to reduce the chances of vomiting stomach contents into the water. Procedures and Guidance Page 18 of 26 Reference No:

19 Appendix G HYDROTHERAPY POOL INSPECTION / RISK AUDIT TOOL DATE: LOCATION: AUDIT UNDERTAKEN BY:.. NAMED PERSON/S RESPONSIBLE FOR THE POOL.. Please tick a box for all questions SECTION 1: ENVIRONMENT Standard 1 The environment will be maintained appropriately to ensure the health, safety and well being of pool users and staff to be carried out by the lifeguard. 1.1 Changing Areas Yes No N/K a. Visual privacy for changing is available (curtained areas) b. Seating is available and suitable for patients who have undergone total hip replacements or other recognised special requirements Please state other c. Changing areas are clean and free from extraneous items d. There is no evidence of multi use toilet items e.g. Creams e. There is an impervious surface available for changing incontinent clients which is cleaned between client use f. Pedal bins are available for soiled pads (yellow bags) g. Disposable gloves are available h. Disposable aprons are available i. Hand washing facilities are available j. Soap / paper towels are available k. Urine bottles are available l. Vomit bowls are available 1.2 Toilet Areas Yes No N/K a. Toilets are in a good state of repair b. Toilet areas are clean c. Toilet areas are free from extraneous items d. Toilet floors are free of standing water e. Separate toilet and hand washing facilities are available for staff f. Hand washing facilities are available and accessible to all g. Soap / paper towels are available h. Toilet paper (on holders) is available i. Sanitary bins are available and emptied on a regular basis 1.3 Poolside Yes No N/K a. Flooring and tiling around the poolside is free from cracked / loose tiles b. The pool side floor is clean c. The pool side floor is free of standing water d. The pool side floor is clutter free e. All lifting aids are easy to clean and in a good state of repair f. Mechanical Hoists are on a PPM programme g. Mechanical Hoists are marked with a maximum user weight h. Pool equipment such as floats, etc are visibly clean and in a good state of repair i. Pool side changing areas are curtained for privacy Procedures and Guidance Page 19 of 26 Reference No:

20 j. Pool side shower facilities are available (inc. disabled access) k. Pool side drinks are available 1.4 The Pool Yes No N/K a. The water level is maintained at the height of skimmer opening b. The water is visibly clean and free of debris c. The scum line is clean and free of dirt & grease d. Grab rails are fitted and secure e. Access steps are fitted and secure f. A pool blanket is fitted g. The pool blanket is in good condition h. The pool is covered with the blanket when not in use i. The pool internal walls and floor are smooth & free of sharp edges SECTION 2: SAFE WORKING PRACTICES Standard 2 Safe working practices will reflect good health and safety management and thus reduce, as far as is reasonably practicable, the risk of harm to staff and all those using the pool facilities. An operational policy must be in place that reflects the following standards. 2. Safe Practices Yes No N/K a. There is a named senior physiotherapist who has overall responsibility for hydrotherapy pool management b. There is a named person responsible for water testing (and taking appropriate action to rectify deviations from standard) c. There is written evidence of water testing, results Total Chlorine and actions taken Free Chlorine (minimum standard 3 times per day) Combined chlorine Air temperature Water temperature d. There is evidence of weekly microbiological test results e. The filtration system is checked, and maintained regularly by a designated person(s) f. Pool turnover time does not exceed 2 hours g. The water temperature is maintained between C h. Water temperature is stable to within 1 of the set temperature i. The ambient air temperature in the pool area is between C j. The atmospheric humidity is maintained at 50 65% k. The pool is back washed at least weekly l. Back wash water is not returned to the pool m. There are procedures in place for dealing with contamination in the pool ph Organic non Organic n. Staff are familiar with the contamination procedures o. A first aid kit is available p. All pool side attendants are trained in Basic Life Support q. All staff using the pool are training in evacuation procedures r. Generic Risk Assessments are carried out and reviewed annually s. Client specific manual handling risk assessments are carried out if appropriate t. There is a Lone Worker policy in place u. There is a Pregnant Worker policy in place v. There is a Personal Protective Equipment (PPE) policy in place w. PPE is used by pool staff in accordance with the policy Procedures and Guidance Page 20 of 26 Reference No:

21 SECTION 3: DISINFECTIONS Standard 3 The supply and use of detergents / disinfectants are appropriate to maintain a safe and pleasant pool environment. 3. Disinfections Yes No N/K a. Chlorine levels are maintained between 4pm 6pm b. The ph levels are maintained between c. Total Alkalinity is maintained between and tested weekly d. Calcium hardness is maintained between and tested weekly e. Water balance is maintained between and tested weekly f. Disinfectant approved by the Trust is available for use with spillages of body fluids (Hospec effervescent tablets) g. COSHH Assessments have been conducted on all substances h. COSHH Data sheets are available for each substance used in the area i. All substances are stored in accordance with COSHH regulations j. A disinfection procedure is available for decontamination of all reusable equipment Procedures and Guidance Page 21 of 26 Reference No:

22 Appendix H Maintenance Schedule Daily Tasks Maintenance Task Acceptable Level By Who Maintenance Task Weekly Tasks Acceptable Level By Who Check alarms All working Lifeguard Check safety equipment location Check ph, chlorine, temperature Pool hall temp and humidity Listen for pump noises Record filter drop Pool vacuumed All working or replacements sought Ph Chlorine 2ppm Temp 37 Lifeguard Pool Manager Pool manager Pool manager Pool manager Lifeguard Thorough clean of pool and poolside Clean water skimmer baskets Backwash twice a week Water sample to laboratory Record pressure filter drop Lifeguard pool manager and maintenance team Pool manager Pool manager and maintenance team Pool manger Pool manager Clean poolside and changing rooms Lifeguard and Pool Manager Termly Tasks Maintenance Task Alternate Pumps Lighting to be checked Pool cover and mechanism checked Safety and play equipment inspected Acceptable Level All functioning By Who Pool manager Pool manager Pool manager Pool manager Procedures and Guidance Page 22 of 26 Reference No:

23 Water Parameters PARAMETER PROBLEM ACTION Temp above 35.5 C TEMPERATURE The physiological effects of immersion make it imperative that the water temperature is controlled correctly between C (ideally ) Temp below 33 C Carry out a backwash to reduce the water level and then refill with cold water or reduce temperature by controls where available For normal hydrotherapy sessions it is doubtful that the patient will enjoy any therapeutic benefit from exercising in water below 33 C seek cause of problem in conjunction with the works department ph It is essential that the correct ph value for pool water is maintained to give effective disinfection Chlorine Free: Combined: ph too low ph too high Free chlorine level is above 4ppm Combined chlorine level is above 1 ppm Free chlorine level is below 1ppm Add sodium carbonate (soda ash) Add sodium bisulphate Backwash to reduce water level and make up with mains water Backwash to reduce water level and make up with mains water Add calcium hypochlorite Alkalinity Total: 75mgl 250mgl Alkaline salts below 75 mgl low Alkaline salts above 250mgl Add sodium bicarbonate Add sodium bisulphate Too high Backwash to reduce the water level and make up with mains water Procedures and Guidance Page 23 of 26 Reference No:

24 Local Procedure for Microbiology Testing The following procedure should be followed when collecting a water sample for microbiology testing: 1. Only bottles supplied by the laboratory should be used for collecting water samples 2. Remove the cap, taking care not to touch the inside of the bottle or cap 3. Hold the bottle by the base and immerse to a depth of 15cms and allow filling 4. Replace the cap, dry the bottle and fill in the required details on the label 5. Place the sample bottle in the insulated bag along with a frozen ice pack 6. Complete the laboratory form, place in the bag with the sample and arrange prompt delivery to Public Health Wales Microbiology Llandough Hospital Penlan Road Penarth CF64 2XX Tel: NB: The sample must reach the testing laboratory within 6 hours Procedures and Guidance Page 24 of 26 Reference No:

25 Appendix I Staff Competency Checklist Name: Although not a mandatory requirement, staff accompanying the students in the hydrotherapy pool should prove that they possess basic water competency skills. Every member of staff (permanent, supply and voluntary) must, under the supervision of the lifeguard prove they possess the following skills: Skill 1 st year test 2 nd year test 3 rd year test 4 th year test 5 th year test 6 th year test Enter and Exit the pool safely without assistance Have an understanding that contact lenses should be worn if needed. Goggles should however, be worn throughout session Walk 2 lengths of the pool unaided maintaining good balance Swim one length of the pool using any stroke Fetch an object from the bottom of the pool Completely submerge head under water Support a child in the water without assistance Use buoyancy aids effectively During child transition into the pool, receive a child from the hoist and remove sling During child transition from the pool, put sling on child and attach safely to hoist Have knowledge of where the telephone and emergency call buttons are located and understand how to operate them Have knowledge of where the lighting/music systemhave knowledge of horizontal lift and spinal board evacuation procedures is located and understand how to turn off/on Understand the Fire Evacuation Procedure and what is expected in the event of a fire Have knowledge the spinal board evacuation procedures and understand their role in supporting the life guard Procedures and Guidance Page 25 of 26 Reference No:

26 Appendix J Swimming/Hydro Individual Risk Assessment: Swimming/Hydro Individual Risk Assessment: Medical Information has been sought, collected and shared Operational Risk Assessment and Policy Read by all staff All staff have undertaken competency test All staff aware of emergency evacuation procedures Manual Handling Risk Assessment Read Noise/lighting in pool hall kept at minimum Yes Pupil Name: No Risk/Severity Medical Condition - Cardiac or circulatory problems, Asthma/respiratory problems Recent serious illness/surgery etc Pupil has no history of any medical condition Pupil has a medical condition but it is well controlled through medication or other means Pupil has severe medical condition which is controlled but can be unpredictable Pupil has severe medical condition which is largely uncontrolled, unpredictable and potentially life threatening GO TO INDEPENDENCE Epilepsy Pupil does not suffer from epilepsy Staff have concerns over unconfirmed epilepsy, seizures or absences Pupil has severe epilepsy condition which is controlled but can be unpredictable Pupil has severe epilepsy that is largely uncontrolled and potentially life threatening. Pupil is swimming in a group more than 1 GO TO INDEPENDENCE Independence Pupil is either: Completely dependent on 1 or 2 members of staff within the pool. Risk is deemed minimal if this is accommodated OR Completely independent and proves to be very little risk Pupil is dependent on adult help but still proves to be a risk when given it OR Pupil is beginning to be more independent in swimming and needs to be given space Pupil poses MINOR risk due to epilepsy or medical condition but is closely supported (*physically*) 1:1 or 2:1. OR Although not *physically* supported, Pupil poses a MINOR risk due to medical conditions/behaviour when allowed to be semi independent in the pool Pupil poses SIGNIFICANT risk because they want to be independent and appreciates space. However, neither swimming competence, behaviour or severity of medical conditions/epilepsy allows staff to fully accommodate. Combination of severe epilepsy/medical condition and Increased independence is a high risk Behaviour Pupil presents with no challenging behaviour Pupil can present some challenging behaviour but is easy to manage and poses very little threat Pupil presents with severe challenging behaviour towards self, staff, pupils and objects can require additional adult help Pupil regularly presents severely challenging behaviour which often results in injury/damage to self, staff, students and others Swimming Competence Pupil is a fully competent swimmer capable of selecting a range of strokes to complete numerous lengths of the pool Pupil able to travel at least one length of the pool unaided using 1 or more strokes. Pupil displays some signs of being able to stay buoyant unaided although performance is inconsistent Pupil unable to stay buoyant or self propel without assistance. Pupil reliant on staff member for complete support/safety whist in the pool Group Numbers Pupil and adult support will be only people in the Pupil and 1 other will use the pool together with Pupil will use the pool as part of a group containing pool pupil does not their support neither no more 3 other pupils (4 Procedures 26 and have Guidance epilepsy has a severe Page medical 26 of pupils total). All pupils 1:1 OR Reference No: condition or epilepsy No group member has reached the spotter threshold Pupil will use the pool in a group totalling 5 or more pupils Pupil will use the pool in any size group where 1 or more pupils has serious epilepsy or serious medical condition as detailed in question 1 and 2