Last week, I was lucky enough to be the Lord Mayor’s Colloquies (an academic conference or seminar) on water and sanitation, where the wonderful Dr Susanne Surman-Lee was speaking. It was an event sponsored by the Lord Mayor and supported by the Worshipful Company of Plumbers.

What has this got to do with bathrooms I hear you ask? Is it because it was on water and sanitation? Is it because these things impact healthcare design? Or are linked with infectious diseases? Is it because of the LAKANA Mali study? You’d like to think, but actually the trigger for this post was none of these things. It was triggered because I have a habit of hiding in bathrooms.

Hiding in bathrooms

I have posted before about networking, and that I’m not a natural in this regard. I have over time developed tools and approaches to aid me, but I still don’t love it. Now for a confession, and to be honest I genuinely don’t know if this is just a me thing as I haven’t really talked about it. Sometimes when I just can’t face networking, I hide in the bathroom of wherever the event is taking place so I don’t have to be in the room until just before the event start so I don’t even have to try. I’ve hidden in some pretty Class A bathrooms in my time, at the Houses of Parliament, at fancy hotels and most recently at Mansion House.

Some days, I just can’t face the sea of people and trying to come up with something interesting that I can bring to the conversation. It is especially bad when entering rooms when I just don’t know anyone or at least anyone well. Occasionally, my game face just fails me and so I find myself locked in a toilet cubicle negotiating with myself about what point I will leave in order to still look like I’m arriving in a timely fashion and with a window to grab some tea.

The negotiation is also about convincing myself to not a) hide at the back of the room, b) just call it quits and go home, and c) look confident and like I haven’t been hiding in a bathroom when I enter the room.

The negotiating doesn’t end here. Many years ago I made a deal with myself. I am allowed to hide in the bathroom, but only pre-event. Once I make it to the room I am not allowed to leave without speaking to at least one person I don’t know. It doesn’t have to be extensive, but it has to be a deliberate act of networking. One of the reasons I find this bit easier is because post event, at least, the one thing I have in common with the other attendees is that we’ve just engaged in the same activity. So that’s the rule, one person, one conversation before I’m allowed to leave. I don’t know if I’m the only one that has these types of rules, but now you all know if you see me hiding out in a bathroom, there is a reason why.

Developing a more than normal interest in bathrooms and water

You won’t just find me in bathrooms at events, however. Working in IPC has waaaaay more to do with bathrooms than I could ever have imagined before I came into post. From overflowing toilets to drain flies, we deal with it all. We often joke that we don’t know which members of the team are Mario and which are Luigi, as even when it isn’t an IPC issue, we still get all the plumbing calls.

As time has progressed, I’ve developed strong opinions on a wealth of topics that I never thought would hold meaning for me, from sink design to tap choice. I’ve also learnt a lot more about IPS panels (the panels at the back of your sink) and TMVs (thermostatic mixer valves) and how both can impact on other areas, such as my need to revalidate my specialist mechanically ventilated rooms.

One of the key things I’ve learnt, as well as being open to continuously learning, is that relationships in this area are key. This is an area where you need to be able to ‘phone a friend’. Friends aren’t just other people in IPC. You need to build relationships with engineers and designers, as well as those people in the lab who can talk you through your water-based results. You simply can’t do this one alone. There are too many factors. Collaboration is key, and the sooner we recognise we can’t do it alone, the more impactful we will be.

Promoted to a bathroom

I don’t know if there’s any meaning behind it, or whether it is just an amusing coincidence, but when I finally got to a point in my career where I was allowed my own office it turned out it was a converted toilet cubicle. My office still says on-call bathroom on the door, alongside one of my favourite things the team have ever given me, my Dame Elaine sign (they always joke it will happen one day). It is a rather compact space, but I love it, and at least they remembered to take the actual toilet out.

The irony of a blog post that starts with how much I hide in bathroom cubicles then discussing how my office is now one is not lost on me. Quite a lot of people don’t like it as a space, as it has no natural light or any ventilation. I don’t know if it’s because I’ve been hiding in bathrooms for way longer than I had a bathroom office, but I find it a really comforting space. I like the lack of distractions. I like being able to spin my chair and reach for anything I need. I like being able to listen to peppy music whilst I work, as I hate working in silence, and not having to worry about bothering others. To me, it’s sanctuary.

Being considered a bathroom expert

One of the things I didn’t realise when I started out as a Healthcare Scientist is how organically interests grow and end up turning into something more. I started involving myself in all things built environment and IPC, because I wanted to understand it better. I wanted to learn more. As time went on that wanting to learn led me to develop more and more questions, as I found gaps in the literature and questions I couldn’t find the answers to. Maybe because I am a scientist, those questions led me to create studies and collaborate with others to gain knowledge that not only solved some things but also created more questions. I’ve also had the painful experience of making bad decisions based on a lack of evidence to enable me to make better ones. Therefore, I think this area (water and water safety) is one that is often overlooked and yet is critical to all healthcare and healthcare environments.

One of the reasons it’s so easy to make less than ideal judgements and decisions in this area is that IPC teams get so little training on this. Most will know something about Legionella pneumophila and Pseudomonas aeruginosa, but very few will know much about other key organisms, such as atypical mycobacteria or Elizabethkingae. What can feel like fairly low consequence decisions based on aesthetic appeal, such as which tap you prefer, can have significant consequences down the line which might not be seen for years. This can make it hard to tie up cause and effect in order to lead to improved learning without external support.

I never aspired to, or meant to be considered an expert in this area, but somehow I have accrued some level of knowledge by being in a Trust that is always building, and having stayed in one place for 20 years to see the cause and effect in real time. For the same reasons, I’ve also published a few papers linked to ways to improve water hygiene, although only a handful.

The main thing I’ve done is establish the Environment Network as a way to share learning and talk through challenges, and more recently, a course that sits alongside it to help support those who are interested and don’t want to make the same trial and error mistakes that I did. I am far from an expert in reality. There’s too much to learn, and the landscape alters too quickly. What I am is intellectually curious and determined to try to learn enough that every decision I make it better than the last one.

Bathroom based recognition

I started this post talking about a Worshipful Company of Plumbers sponsored event at Mansion House and my bathroom based adventures. I thought I should finish it by telling you why I was there and how this transpired in case any of you would be interested in joining me at future versions.

As I said, there don’t seem to be that many people who work clinically who are interested in water safety, although I’m pleased to say the number is increasing. There are, however, amazing women working in this area from the microbiology perspective, women like Dr Susanne Surman-Lee and Elise Maynard. The brilliant thing about these women is that they are truly interested in engaging with others and also raising up other women. I first met Susanne 17 years ago as a trainee when she was working at UKHSA, she won’t remember the event but she made a definite impression on me, and I’ve known Elise for over a decade. They are my ‘phone a friends’ when I need expert advice. They also lead on a bunch of different guideline writing groups in relation to water, and over the years have been kind enough to include me so that these groups, which are usually fairly heavily engineering led, include a clinical perspective.

Over the years, we have written a few BSI guidelines together, and the one that I think is most useful to those of you out there in IPC is this one, BS 8580-2:2022 Water quality. Risk assessments for Pseudomonas aeruginosa and other waterborne pathogens. It has a wonderful table at the back from Elise that contains all of the kinds of organisms you are aiming to control and if there are any specific areas to be considered, such as Klebsiella pneumoniae and sinks. We’re currently writing a new one to help people make sampling based decisions, and one on atypical mycobacteria should hopefully start later in the year. Susanne also organises the Royal Society of Public Health water webinar series, and I’ve been fortunate enough to deliver a couple.

All of which ended up with me being here:

In 2022, I was asked if I’d consider becoming a Liveryman for the Worshipful Company of Plumbers, linked to my work on water and women in leadership. It’s been a fascinating process, and at some point I might do a blog post on it. Needless to say, I agreed and in May 2023 I was clothed in the Livery. One of the great things about joining has been to meet so many people who are also really interested in how we manage water better and differently. There are also so many different perspectives. At the Mansion House event, my one conversion ended up being the leader of a sustainability nonprofit who was interested in using STEAM (science, technology, engineering, arts and mathematics) approaches to change how people think about water. This strikes a bell with me, as some of the challenges in the healthcare setting are around people thinking of sink areas being ‘clean’, whereas they are frequently highly loaded with bacteria and therefore potential risk.

Members of my team now jokingly refer to me as Her Plumbship, and all plumbing queries are light heartedly directed my way. The thing is, in this area, none of us can do it alone. I’m not a plumber (despite what my CV says). Nor am I an engineer, an environmental microbiologist or sustainability expert. If we are to make things better, make thing safer and deliver on key goals like those listed by the UN, we have to come together. We have to embrace the fact that there is no such thing as a stupid question, be prepared to stick our heads above the parapet and be uncomfortable in our lack of knowledge in order to work towards a better shared understanding.

All opinions in this blog are my own