WATER HYGIENE AND SAFETY


associated with sink colonisation, and environmental surface contamination from CPE. Selective pressure from antibiotic excretion in the urine and faeces has been proposed as a potential contributor to the success of multidrug-resistant organisms in hospital plumbing.4 The WSP should include measures to prevent ingress of this type of cross-contamination, and should also consider the proposed guidance in healthcare. For example, the prevention of contamination should also include the avoidance of splashing during the use of washhand basins, by maintaining clear zones of at least 0.5 m around the basins, and/or incorporating screens. Currently this is not being observed due to the restricted space in clinical areas.


Hospital outbreaks HTM 04-01 Part C references the multidrug-resistant Pseudomonas aeruginosa outbreaks in two hospitals and the association with contaminated hospital wastewater systems.5


The outbreaks occurred in two English hospitals;


each involved a distinct genotype of MDR-P. One outbreak was hospital-wide, involving 85 patients,


and the other limited to four cases in one specialised medical unit. The source of many such infections is unclear, although there are reports of hospital outbreaks of P. aeruginosa related to environmental contamination, including from tap water. The investigation and intensive sampling highlighted, as possible causes of contamination of the clinical areas, faulty sinks, shower tray (poor drainage) and toilet design, clean items being stored near sluices, and frequent blockages and leaks from waste pipes. The investigation went as far as to suggest that the blockages were due to paper towels, wet wipes, or improper use of bedpan macerators. The outbreaks highlight the potential of hospital waste systems to act as a reservoir of MDR-P and other nosocomial pathogens.6


Multidrug-resistant (MDR)


and extensively drug-resistant (XDR) Pseudomonas aeruginosa are frequent causes of serious nosocomial infections that may compromise the selection of antimicrobial therapy. This is particularly important in patients with cystic fibrosis (CF), who may be chronically colonised, and suffer from recurrent infections and disease exacerbations due in part to the limited efficacy of antipseudomonal agents. Multidrug-resistant organism infections are hard to treat, because they do not respond to many common antibiotics, even the most powerful ones. However, certain antibiotics can still help control MDROs in most people. The doctor will try to find the type of MDRO causing the illness, which is essential in selecting the best antibiotic. Treatment with the wrong antibiotic can slow recovery and make the infection harder to cure. Steps which we can begin to take to reduce the risk and implement control measures include replacing sinks with easier-to-clean models less prone to splashback, educating staff on reducing blockages and inappropriate storage, reviewing cleaning protocols, and reducing shower flow rates to reduce flooding. It is equally important to be vigilant, and to report risks to the right personnel to undertake corrective measures to reduce microbial spread of contamination. Today we have the opportunity to ensure that any


new hospital building design and specification takes into consideration wastewater, not just from a clinical and patient safety standpoint, but also in terms of climate change impact, and mitigation and reduction of the carbon footprint. Careful consideration must be given at the design stage to the functionality of water outlets in the healthcare setting (augmented and intensive care units). The Infection Prevention and Control team needs to


work closely with the Water Safety Group and Capital Project team to ensure that the following factors are being taken into consideration):7 n Measures to control the spread of microorganisms in healthcare premises include handwashing, but also the regular use of antimicrobial hand-rubs, as this can result in a significant reduction in the use of washhand basins. Under-use of taps encourages colonisation and growth with Pseudomonas aeruginosa, Legionella, and other waterborne organisms. The design team should be aware of this, and accordingly consider how local infection policies regarding hand hygiene and the use of antimicrobial hand-rubs might impact on the frequency of use of washhand basins, and the volume of water being distributed.


n The most effective management of showers will be achieved via the removal of unnecessary ones and the regular use of others.


n To prevent water stagnation, check for infrequently used outlets – assess frequency of usage and – if necessary – rarely used outlet(s). For example, the provision of showers in areas where patients are predominantly confined to the bed, and the resulting lack of use, could lead to stagnation.


Augmented care locations Augmented care settings should be carefully designed to ensure the correct positioning and number of water outlets installed, to prevent the additional risk to patients from outlets in close proximity to the patient, especially if the outlets are ‘low use’, creating water stagnation and risk of microbial contamination. Seldomly used outlets need to be put on flushing regimes (prevention of bacterial load and waste of wholesome water), which can be implemented via mechanical auto flush. However, more often than not such regimes are implemented by manual action, which is ineffective from both a time and cost standpoint, and very difficult to monitor. Furthermore, water use has a direct association with climate change mitigation. Significant amounts of energy are used in the heating, supply, and treatment of water. Water UK (2007) estimates place the carbon costs of water supply at around 0.271 grams of CO2


per litre, a


figure likely to be much higher if the water is heated. More efficient use of water in healthcare facilities could therefore result in a significant reduction in their carbon footprint. Managing water efficiently across the healthcare estate will require a wide range of approaches – one of which could be a revision in the correct amount of water outlets installed, based on risk and possible usage. Infrequently used outlets or redundant ones – due, for example, to a


August 2025 Health Estate Journal 51


An ozonation tank able to produce ozone in the purification and decontamination process.


Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16  |  Page 17  |  Page 18  |  Page 19  |  Page 20  |  Page 21  |  Page 22  |  Page 23  |  Page 24  |  Page 25  |  Page 26  |  Page 27  |  Page 28  |  Page 29  |  Page 30  |  Page 31  |  Page 32  |  Page 33  |  Page 34  |  Page 35  |  Page 36  |  Page 37  |  Page 38  |  Page 39  |  Page 40  |  Page 41  |  Page 42  |  Page 43  |  Page 44  |  Page 45  |  Page 46  |  Page 47  |  Page 48  |  Page 49  |  Page 50  |  Page 51  |  Page 52  |  Page 53  |  Page 54  |  Page 55  |  Page 56  |  Page 57  |  Page 58  |  Page 59  |  Page 60  |  Page 61  |  Page 62  |  Page 63  |  Page 64  |  Page 65  |  Page 66  |  Page 67  |  Page 68