WATER SYSTEM SAFETY
Conference highlights infection risks from sinks
Some of the key infection risks posed by water systems in hospitals and other healthcare facilities were discussed at the Infection Prevention Society’s Infection Prevention 2024 annual conference at the ICC, Birmingham. One of the topics to generate considerable debate was the ‘pros and cons’ of removing washbasins from rooms housing ‘high-risk’ patients where risk assessment indicates too high an infection risk from outlets and associated drainage. Louise Frampton, the editor of HEJ’s sister magazine, The Clinical Services Journal, reports.
Concerns over waterborne infection risks in UK hospitals have hit the headlines over the past decade. Pseudomonas bacteria were found in the water systems of Belfast’s new state-of-the-art maternity hospital;1
21 patients were
infected by bacteria in the water supply at the Royal Papworth Hospital,2
and an infection outbreak in the child
cancer wards at the Queen Elizabeth University Hospital, Glasgow, is also believed to have originated from the hospital’s water systems.3 These are just some of the high-profile incidents reported in the national press – demonstrating the need for greater consultation with Infection Prevention and Control (IPC) teams, as well as further specialist training with regards to the built environment. During the conference, speakers highlighted the need for a better understanding of the risks posed by water systems and wastewater, across all stakeholders responsible for designing, building, and commissioning, hospitals. ‘Blindly following guidance’ is not enough to mitigate the risks, they warned. During the conference, delegates heard from Dr.
Michael Weinbren, a Specialist Advisor in Microbiology to the New Hospital Programme, who gave an insight into some of the outbreaks that have been found to have originated from hospital water / wastewater systems – including new builds. He pointed out that the first requirement for a hospital is that it “should do no harm”; patient safety should be “front and centre”.
Not ‘blindly following guidance’ While guidance is important, when it comes to the design, construction, and commissioning, of hospital facilities, “blindly following guidance can prove very dangerous,” he warned. He gave the example of the guidance for ‘six-monthly water testing for Pseudomonas’ – bacteria can appear between testing regimes over this period, so following this guidance could lead to a failure to identify and act rapidly on any emerging threats. In fact, the risks of waterborne infection have been well documented, ever since the 1976 Legionnaires’ disease outbreak in Philadelphia. However, the issue has gained significant attention in the UK in the past decade, following an outbreak of Pseudomonas aeruginosa which claimed the lives of three babies at Belfast’s Royal Jubilee Maternity Hospital, in 2012. There is now a national action plan, and in recent
months we have seen the publication of the NHS Estates Technical Bulletin (NETB) No.2024/3, which looks at ‘Designing safe spaces for patients at high risk of infection from nontuberculous mycobacteria and other waterborne pathogens’ (27 August 2024).
“If you can prevent transmission in the first place, it’s much better than antimicrobial stewardship,” Dr. Weinbren commented. The highly experienced microbiologist added that the AMR national action plan is a “step forward”, as it calls for designers, architects, engineers, and facilities managers, to work with IPC teams to deliver facilities, so that IPC needs can be anticipated. However, not everyone in infection prevention has been trained in the built environment. If people don’t know the answers, they need to be able to speak up, and we need to train people, he asserted.
Removable shower insert He went on to highlight some of the risks posed by water outlets and wastewater, as well as a possible solution developed to address the risks associated with shower drains, with a removable and autoclavable shower insert, designed to prevent patients having direct contact with wastewater. “We need to think about the design of showers in the future,” he asserted. Dr. Michael Weinbren went on to highlight research
by Fucini et al which showed that when ITU rooms have a sink located within them (as opposed to outside), this can result in an increased rate of Pseudomonas-associated infection.4
Approximately 5% of patients, in a study by
Halstead et al, ‘definitely’ acquired their P. aeruginosa from their water outlets in the intensive care unit.5
April 2025 Health Estate Journal 37
Pseudomonas aeruginosa bacteria have been found in the water systems of a number of recently built hospitals, in some high- profile, well-publicised cases.
AdobeStock / Dr_Microbe
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