WATER SYSTEM SAFETY


What is down a sink? Dr. Garvey went on to highlight the


Dr. Mark Garvey highlighted the risks of infection transmission from the environment, including hospital sinks, as part of the Tina Bradley Lecture, in a presentation titled: ‘Scoping out the IPC landscape’. Dr. Mark Garvey, a Consultant Clinical Scientist, Clinical Director of IPC, and Director of the Hospital Infection Research Laboratory, highlighted some examples of serious transmissions that have occurred – including incidents involving transmission of Hepatitis C in a renal healthcare setting,8


and


waterborne Pseudomonas aeruginosa in a haematology unit.9 Transmission of infection from trays used for IV prep was identified as a serious concern in both incidents. In the haematology unit, blue IV trays were found in a sink which had no filter. This sink was proven to be a source of Pseudomonas aeruginosa, which led to three patients experiencing central line infections on the unit. Therefore, we need to think carefully about how these pieces of equipment are cleaned and decontaminated, and the risks posed by sinks, he warned.


findings of further research which looked at Pseudomonas aeruginosa infection in augmented care. This project examined the molecular ecology and transmission dynamics in four large UK hospitals.10 Over a 16-week period, all water outlets


in the augmented care units were sampled for P. aeruginosa, and clinical isolates were collected. They found that 20-30% of the water outlets tested positive for P. aeruginosa. The samples were genome sequenced, and patient isolates examined from previous months. As a result, they found that 60% of the isolates taken from patients who had experienced a P. aeruginosa infection matched the water isolates. In another paper, ‘efforts to engineer out


P. aeruginosa’ included new tap outlets and point-of-use filters, as well as holistic measures, such as a revised tap cleaning method, and appropriate disposal of patient wastewater. These engineering and holistic interventions resulted in a 50% reduction in the number of P. aeruginosa clinical patient isolates over a year.11 Dr. Mark Garvey further presented


Sinks have the potential to “harm and kill patients”,


One of the conference speakers, a DIPC, and Past-President of the IPS, Pat Cattini, pointed to a growing body of research highlighting the potential infection risks associated with exposure to water outlets.


Dr. Michael Weinbren warned. He also highlighted daily practices in hospitals which represent a risk – such as filling water jugs by standing them in the sink, so the jug is in contact with the wastewater drain. This can lead to infection transmission. To overcome this risk, specially designed water dispensers can be introduced that ensure there is no contact with the sink or wastewater drain.


Ultimately, he pointed out that if you cannot see the risk, you cannot mitigate it. A risk-based approach is essential. However, while we are good at recognising that patients have an infection, we are not so good at tracing this back to the water/wastewater systems. “I think it would be fair to say that if we were able to


a slide titled: ‘What is down a sink?’, featuring graphic photos of biofilms and contamination, as well as positive samples cultured from sinks – including CPE. He also presented some revealing


research on the extent of the ‘sink splash zone’.6


This study involved placing paper


towels on the floor around the splash zone of the sink. They ran the tap to see how far it would splash, and found that it splashed up to 2 metres in distance – demonstrating the risks of transmission to patients and contamination of medical equipment. “When you look at what is around a sink on an ITU, you will find IV trolleys and the patient’s bed – what is down that sink and what is splashing about can easily get on the patient. Water has a major role to play in infection control,” Dr. Garvey commented.


He concluded by highlighting the paper by Hopman et al, which involved the removal of sinks from patient rooms and the introduction of ‘water-free patient care’, on an ICU, which resulted in a significant reduction in colonisation with MDR Gram- negative bacteria.7


track back every transmission event to the source, the design of the built environment would be completely different in our buildings in relation to water/wastewater,” commented Dr. Michael Weinbren.


Reducing water outlets in a new build hospital Pat Cattini, a Past President of the IPS, and Corporate Director of Infection Prevention and Control at University Hospitals Sussex, highlighted a project underway at the Trust to reduce water outlets in the design of a new cancer centre, being built as part of the New Hospital Programme. The new cancer centre, once completed, will


centralise the Trust’s non-surgical haematology and oncology services, and the accommodation will be in single rooms with an en suite. However, the initial planned design would have meant significant exposure of this vulnerable patient group to water outlets (4-5 outlets if following the Health Building Note [HBN] – which includes a clinical handwash basin, toilet, shower, and patient washbasin). Pat Cattini pointed to a growing body of research that highlights the potential infection risks associated with exposure to water outlets, including research by Mark Garvey et al, which was presented earlier in the conference.6


This study looked at the ‘splash


zone’ around water outlets, highlighting the potential infection risks (particularly from Pseudomonas aeruginosa) associated with water outlets on an ICU. Joost Hopman et al‘s study also reported a reduced rate of intensive care unit-acquired gram-negative bacilli after the removal of


38 Health Estate Journal April 2025


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