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WATER HYGIENE & SAFETY


pre-checked to ensure that there were effective water safety plans implemented, taking account of patients at higher risk of waterborne infections to minimise the risk of infection. As there was so little time, it is to be expected that such audits were not carried out, so it is essential then that there is an increased awareness among staff caring for these patients of the precautions needed to prevent waterborne infection. It is also important that there is increased surveillance and appropriate testing to ensure that any potential infections would be recognised and treated in a timely way. The potential consequences of delays in giving appropriate treatment could result not only in severe illness – in many cases requiring intensive care – but also life changing sequalae, including the loss of limbs and death.


Figure 3: A thermostatic mixing valve with biofilm.


Buildings lying empty A huge challenge, which is going to require some innovative management, is the large number of buildings that have been lying empty or have been only partially occupied. Healthcare buildings at risk include dental practices, and other buildings where there is specialist equipment used for treatment or patient diagnosis, where stagnant water in equipment, as well as that within distribution systems, has the potential to pose risks over and above the current crisis. To ensure that these buildings are safe to reopen is going to require


planning, and potentially a considerable amount of remedial actions. It is important that not only the water in distribution is risk assessed and managed appropriately, but also where there is any equipment containing water that has been left to stagnate. Dental unit water lines are a specific example, and guidance can be found as to how to manage these effectively on the ESGLI (https://www.escmid.org/ research_projects/study_groups/ legionella_infections) and Legionella Control Association (https://www.legionellacontrol.org.uk/ news/85/) websites.


Infection risk from other waterborne pathogens The need for many interventions in ventilated patients also increases the risk of infection from other waterborne pathogens, including P. aeruginosa, other Gram-negative bacteria such as Stenotrophomonas, and Burkholderia species etc. Infections caused by P. aeruginosa and other similar bacterial species can affect every part of the body where they can gain access, especially where there are breaches in skin integrity, and these can be life- threatening. No one should forget the outbreak associated with Neonatal Intensive Care in Northern Ireland which killed three babies, which was associated with the colonisation of relatively new tap inserts.8


P. aeruginosa is also inherently resistant to common antibiotics, acting as a reservoir of antibiotic resistance.9 It is frequently found in drains, including of clinical washhand basins, especially where these are used to dispose of patient fluids, excess infusions, and wastewater.10–12


There is much evidence


that infections can be caused directly by splashes from outlets reaching patients if beds are too close to sinks, and indirectly from equipment used for patient treatment, if it has been contaminated by leaving trolleys or infusion sets etc that have been within the splash zone.13


June 2020 Health Estate Journal 53


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