WATER HYGIENE AND SAFETY
Managing the risk of P. aeruginosa in healthcare
Reducing the risk of Legionella is hard-wired in healthcare facilities, but recently attention has turned to another waterborne pathogen – Pseudomonas aeruginosa. According to Public Health England,1
provides a
guide to assessing the risks posed by P. aeruginosa in healthcare settings. Carole Armstrong, Marketing manager at Delabie, looks at the implications for design and specification when managing these risks.
Whether for a new-build or when refurbishing existing premises, responsibility for managing the risk of infection by P. aeruginosa lies not only with the duty-holder or responsible person, but also with the architects, design engineers, manufacturers, installers, and operational teams. Their role is to ensure that – at every stage, from brief to hand- over and operation – the risk is removed or reduced as far as possible. P. aeruginosa is a naturally occurring pathogen that thrives in damp conditions, requiring very few nutrients, a source of oxygen, and ambient temperatures (4-42˚C) to proliferate. Its ideal habitat is the outlet and its associated pipework. The first challenge for healthcare facilities is that the incoming water is not sterile, and it is not possible or practical to prevent all waterborne opportunistic pathogens entering the system. The solution, therefore, is to manage the water distribution system to prevent proliferation and minimise contamination.
Filtering out the microbes In areas where patients are severely immunocompromised – for example with neonates, and on intensive care and transplant wards, eliminating the risk means improving the bacteriological water quality above that required by national drinking water regulations. This involves installing sterilising grade point-of-use (POU) filters. BS 8580-2:2022 states: ‘Studies have shown that installing
sterilising grade POU filters or removing all outlets in areas where there are highly immunocompromised patients will significantly reduce overall levels of hospital-acquired Gram-negative infections.’2
POU filters must be suitable
for their intended use (0.2 µm sterilising grade in healthcare), so that when installed there is sufficient activity space to allow handwashing and receptacles to be filled without touching any surface, including the waste. Delabie’s Biofil filters incorporate a hollow fibre microfiltration membrane
in the year
to March 2021, 39% of P. aeruginosa cases originated in healthcare, exacerbated by the increase in hospital admissions during the COVID-19 pandemic. The new BSI code of practice, BS 8580-2:2022,2
In patient care areas, sinks should be used exclusively for handwashing to prevent cross-contamination.
with a porosity of 0.2 µm absolute-rated. This guarantees a bacteriological quality superior to that of the drinking water system without changing its chemical composition.
Increased filtration surface Hollow-fibre technology provides an increased filtration surface area within a compact housing, so spout filters can replace stainless steel spouts on Delabie mixers without compromising drop height and activity space. Manufacturer guidelines provide information on correct installation and operating conditions – such as recommended flow rate, system pressure, and longevity. Once installed they must be regularly checked for leaks. If the incoming water supply is heavily charged, or filter lifespans are not respected, clogging may reduce the outlet flow rate. This can lead to an increased contamination risk, especially if the filter is removed prematurely without addressing the source of contamination.
Sufficient stocks of filters (and connectors) should also be held to allow filters to be changed according to manufacturer recommendations, and allow for spares should a contamination episode occur. Maintenance and cleaning staff must also be made aware that filters are single-use, and cleaning practices must ensure that there is no cross-contamination from the waste to the filter. The Royal Society for Public Health3
provides guidance on how
to clean taps and sinks, including those with POU filters installed.
Dangerous droplets For seriously immunocompromised patients the inherent risk is similar to that of Legionella contamination, i.e. waterborne pathogens such as P. aeruginosa can become airborne via aerosols or droplets. The production of aerosols is most commonly associated with aerators in taps and showers. Health Building Note 00-094
states that aerators should not be used in healthcare facilities; October 2022 Health Estate Journal 47
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