WATER SYSTEMS temperature.
n Water stagnation (often in low-use outlets).
n Badly designed cold water tanks and expansion vessels.
n Complex components incorporating rubber and plastic.
n Foul drainage, which can become blocked.
n Poor water flow. n Disposal of body fluids and environmental cleaning agents at clinical washhand basins.
n Washing of patient equipment in such basins, and their use for storing equipment awaiting decontamination.
n Contaminating the tap by touching the spout when handwashing.
HTM 04-01: Safe water in healthcare premises – Part B: Operational management recommends establishing a multidisciplinary Water Safety Group in hospitals and other healthcare facilities.
n Gastrointestinal. n Central nervous system. n Ear infections. Keratitis caused by P. aeruginosa can cause blindness, and the bacterium also affects patients with severe burns, cancer, and AIDS. Control of P. aeruginosa bacteria in healthcare settings is always challenging, making clinical risk assessments essential, as per HTM 04-01 and BS8580-2:2022: Part 2: Risk assessments for Pseudomonas aeruginosa and other waterborne pathogens – Code of practice, to establish the correct scheme of control.
Strict hygiene and good training Key in controlling and eliminating P. aeruginosa are strict hygiene procedures, supported by relevant training and information for Estates personnel, housekeeping / cleaning staff, and everyone working in, and visiting, a healthcare environment. Information on hand hygiene should be clearly encouraged, especially as P. aeruginosa transmission is possible person-to-person. The key is to prevent the bacteria taking hold in the water systems and areas where contamination can occur (damp surfaces). Any bacteria will – in a suitable environment – establish a biofilm, which is extremely difficult to eliminate from surfaces. Sources of contamination leading to biofilm formation include: n Dirty taps, shower heads, and adjustable flow shower heads.
n Rusty and scaled-up flow straighteners. n Unsuitable materials. n Contamination during water systems’ construction and repair.
n Non-compliant hot / cold water 36 Health Estate Journal February 2023
n Incorrect tap and shower cleaning. (Taps should be cleaned before the rest of the clinical washhand basin, with care to avoid transferring contamination from basin to basin).
n Using non-fillable single-use bottles for antimicrobial hand-rub / soap.
n Ensuring that reusable containers containing environmental cleaning agents are used in a way that protects them from contamination with P. aeruginosa.
n Ensuring appropriate positioning of soap and antimicrobial hand-rub dispensers. (The compounds in these products can be a nutrient source to some microorganisms).
n Keeping areas dry, since bacteria thrive in moist environments.
Other difficult-to-eradicate bacteria Another difficult-to-eradicate bacterium, Klebsiella pneumoniae, can affect middle-aged and older men, and is becoming antibiotic-resistant. Its natural environmental niches are the soil, skin, mouth, and intestines. The Gram-negative bacterium can cause healthcare- associated infections including pneumonia, bloodstream infections, wound or surgical site infections, meningitis, and sepsis. For infection transmission, a person must be exposed to the bacterium; i.e. K. pneumoniae must enter the respiratory tract to cause pneumoniae, or the blood to cause a bloodstream infection. Preventing Klebsiella infections
spreading requires specific infection control precautions, including strict hand hygiene – preferably using an alcohol- based hand rub (60-90%), or soap and water if hands are visibly soiled. Alcohol- based hand rubs are effective against these Gram-negative bacilli, and wearing gowns and gloves when entering rooms housing patients with Klebsiella–related illnesses is essential. Healthcare facilities must also follow strict cleaning procedures. To prevent infection spread, patients also should clean their hands very frequently, including: n Before preparing or eating food.
The current ISO standard methods for the detection and enumeration of Legionella are included within the scope of accreditation to EN ISO 17025.
n Before touching their eyes, nose, or mouth.
n Before and after changing wound dressings or bandages.
n After using the toilet. n After blowing their nose, coughing, or sneezing.
n After touching hospital surfaces.
Benefits of strict hand hygiene Correct hand hygiene in healthcare must be strictly observed to slow down, if not eradicate, hazardous microorganisms. The COVID-19 pandemic highlighted its importance to everyone. The other mycobacterium of concern
is Nontuberculous mycobacteria (NTM),4 with pulmonary infections a growing global issue, especially among those with pre-existing health conditions. BS 8580-2 :2022 Part 2: Water quality Risk assessments for Pseudomonas aeruginosa and other waterborne pathogens – Code of practice, emphasises the importance of non-tuberculous mycobacteria, or NTM – a group of bacteria that causes rare lung infections sometimes known as NTM pulmonary disease.
Risk assessment key Risk assessment is important in determining the correct scheme of control for NTMs in areas housing severely immunocompromised patients – including transplant units, haematology- oncology units, cystic fibrosis units, and ‘high-risk’ augmented care units. NTM predominantly cause pulmonary infections, but also skin, soft tissue, and post-operative infections. The bacteria are found in soil and water, and can be present in man-made water systems. Like
Image used courtesy of the Department of Health
Image used courtesy of the ISO
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