WATER SYSTEM HYGIENE & SAFETY
Frequency of P. aeruginosa sampling in need of re-think
Karina Jones of Eta Projects, an IHEEM-registered Authorising Engineer (Water), questions whether existing HTM guidance on the frequency with which healthcare engineering teams and/or external contractors take water samples for Pseudomonas aeruginosa is in urgent need of review and updating – especially as regards areas such as augmented care wards, where patients are at particularly high risk of infection.
Following the Pseudomonas aeruginosa outbreaks that occurred in Northern Ireland during December 2011 and January 2012, a request by the Minister for Health and Social Services and Public Safety was made to The Regulation and Quality Improvement Authority to undertake an Independent Review of the incidents of Pseudomonas aeruginosa infection in neonatal units in Northern Ireland in 2012, and a final report was published in May 2012.1
The report highlighted the potential
risks from contamination of taps, and inadequate communication with those who needed the information the most.
Chief Nursing Officer’s letter At the time, the Chief Medical Officer, Deputy Secretary / Chief Estates Officer and (Acting) Chief Nursing Officer, issued a joint professional advice letter, HSS(MD)16/2012, to disseminate new guidance on Water Sources and potential Pseudomonas aeruginosa contamination of taps and water systems – Advice for augmented care units (including neonatal units caring for babies at levels 1, 2 and 3). This Northern Ireland guidance was closely based on the guidance issued in England on 30 March 2012. Incorporating relevant recommendations from RQIA’s interim report, the guidance provides advice on: n Assessing the risk to patients if water systems become contaminated with Pseudomonas aeruginosa or other opportunistic pathogens.
n What actions to take if water systems become contaminated with Pseudomonas aeruginosa.
n Protocols for sampling, testing, and monitoring water for Pseudomonas aeruginosa.
n Developing local Water Safety Plans. The Department of Health issued Water
systems Health Technical Memorandum 04-01: Addendum Pseudomonas aeruginosa – advice for augmented care units in March 2013. This was subsequently replaced with the current HTM 04-01 Part B and C issued in June 2016.2
Biofilm build-up (which may contain P. aeruginosa) can be evident ‘within weeks’ under ideal conditions.
HTM 04-01 guidance followed The HTM 04-01 guidance is followed by all who hold responsibility for water quality and the associated environment in healthcare, including elevated risk areas such as augmented care wards, to ensure the safety of all patients. In addition to the HTM, the British Standard guidance and recommendations were issued in late January 2022 (BS 8580-2:2022: Water quality Part 2: Risk assessments for Pseudomonas aeruginosa and other waterborne pathogens – Code of practice). Pseudomonas aeruginosa bacteria are
listed in the Health and Safety Executive publication, The Approved List of biological agents, Advisory Committee on Dangerous Pathogens, as human pathogen hazard group 2.3
belongs to the same hazard group as Legionella pneumophila. This hazard group description states: ‘Can cause human disease and may be a hazard to
employees; it is unlikely to spread to the community, and there is usually effective prophylaxis or treatment available.’ P. aeruginosa is a species of
considerable medical importance; strains of P. aeruginosa can be multidrug- resistant pathogens recognised for their ubiquity, their intrinsically advanced antibiotic resistance mechanisms, and their association with serious illnesses – hospital-acquired infections such as ventilator-associated pneumonia and various sepsis syndromes.4
Knowing This bacterium
that Pseudomonas aeruginosa bacteria are opportunistic pathogens which can be found in water systems and in the environment, with devastating effects on human health, our concern is that the current sampling strategy guidance in HTM 04-01 Part B is insufficient for augmented care wards, where patients often undergo invasive medical procedures, and inevitably where the patient’s immune system is
March 2024 Health Estate Journal 43
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