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HOSPITAL & HEALTHCARE FACILITIES


KICK THE HAND AND BUCKET METHOD


Shower hoses known to be cleaned by a ‘hand & bucket’ procedure have been


found to contain significantly high levels of bacteria. Here, W.E.T provides a glimpse into their recent research project investigating the link between showers and Healthcare Associated Infections (HCAIs)


Why is this being researched? According to the National Institute for Health and Care Excellence (NICE) up to 300,000 patients a year acquire a Healthcare Associated Infection (HCAI) as a result of care within the NHS. To help combat this, NHS Improvement have tasked Infection Prevention and Control teams with the objective of reducing the number of healthcare associated Gram-negative bloodstream infections by 50%, by March 2021.


More specifically, Public Health England, the body responsible for monitoring the number of infections that occur in healthcare settings, extended the surveillance of Gram-negative organisms to include Pseudomonas aeruginosa, which was recently mandated in September 2017.


What is the current problem? A shower hose will often contain more bacteria than the rest of the building’s plumbing system. A research team led by Frederik Hammes has been investigating this topic for the past four years. In their latest global study, they analysed biofilms in 78 shower hoses from 11 countries, and in 21 of them, they detected legionella.


H&S guidance documents such as HTM 04-01 and HSG 274 provide clear advice with regards to regular cleaning and disinfection of showers. As a result, maintenance teams and water hygiene companies have quite rightly included this as a PPM task in their water hygiene control schemes, adopting a hand and bucket cleaning and descale.


During W.E.T’s research, one study took 16 shower hoses from healthcare settings known to be cleaned using a hand and bucket methodology and tested them for TVCs and Pseudomonas. Around 94% of these hoses were found to be contaminated with Pseudomonas, with an average count of nearly 200,000 cfu / 100 ml sample.


This result may seem high against routine sampling at the shower outlet, which is due to the methodology of sampling. Instead of simply relying on planktonic counts at the outlet, W.E.T dissected the hoses into 10mm lengths and vortexed the material in a sterile solution, which released biofilm and bacteria off the internal surfaces. This demonstrated the high levels of contamination adhered to the internal hose surfaces, which provide perfect breeding grounds for opportunistic pathogens such as Legionella, presenting a real risk to shower users.


Why are hand and bucket procedures


It is widely accepted that showers are a source of contamination and a distributor of pathogenic bacteria such as Legionella pneumophila and Pseudomonas aeruginosa. This is because showers are an ideal environment for the development of biofilms as they operate within temperatures prime for bacteriological proliferation, contain crevices which harbour bacteria and are manufactured from materials that are nutrient rich. Combined with the shower atomising water, it is logical to determine showers as a key risk for managing HCAIs.


68 | TOMORROW’S FM


seemingly not working? There are several possible limitations with the hand and bucket process including; too much focus on the shower head instead on the shower hose and air pockets during disinfection; preventing full surface contact of the disinfectant; pitted surfaces of materials hampering disinfection by shielding biofilms; organic matter and biofilm not effectively removed from the shower hose length; and the contact time of disinfectant not being sufficient enough.


Other limitations can include the fact that disinfectant chemicals are not suitable to penetrate thick biofilms and there is a bias towards descaling rather than disinfection. It’s also important to consider that there are inconsistent procedures because of a lack of quality


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