WATER SYSTEM SAFETY
Scope of Pseudomonas risk assessment The scope of the Pseudomonas risk assessment should include not just a physical assessment of assets, but also how systems and equipment are used directly and indirectly – including as ice, for personal hygiene, diagnosis and treatment, decontamination and cleaning purposes, and all other potential sources of exposure. All potential modes of transmission, and who might be at risk, should be considered. For example, assessors should include the risk of cross-contamination from contact, splashing, and person-to- person transmission, and the impact of ineffective cleaning and flushing processes. To verify that a risk assessment for PA
is valid in a healthcare setting, it should be undertaken by a multidisciplinary team to ensure that all relevant hazards, hazardous events, and all systems and relevant equipment, are considered, together with other risk factors – including the way water-containing or storing devices are used, all potential modes of transmission, and the susceptibility of those likely to be exposed.
Clinical assessment The risk assessment should take account of all relevant environmental and clinical factors which may lead to contamination, e.g., poor cleaning and storage techniques,
Inserts such as flow straighteners and water-saving devices in taps have been shown to increase the risk of colonisation significantly, and transmission of Pseudomonas aeruginosa infection.
and all possible transmission modes, and should also consider risk factors within the associated environment, such as the potential for transmission from personnel, and contaminated outlets, sink traps, and drains – leading to conditions which can encourage the colonisation and growth of waterborne pathogens and transfer of antibiotic resistance. For healthcare premises, risk assessors should check that there is adequate clinical surveillance. Where this has been enhanced due to expected levels of a potential waterborne pathogen for a particular area, there should be processes in place to investigate these, with input from the Infection Prevention and Control Team (IPCT) representative on the WSG,
to provide assurance that surveillance would be effective at identifying cases, especially where there have been changes in detection rates of pathogens which might be associated with transmission from water.
Reducing HCAIs The aim of both clinical and environmental surveillance is to reduce healthcare- associated infections. Several key stages should be in place to verify that surveillance is effective, including microbiological sampling from both patients and the environment, and appropriate laboratory testing and typing, followed by collection, validation, analysis, and interpretation of data. Microbiological surveillance is an
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June 2022 Health Estate Journal 27
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