DECONTAMINATION
‘definitely’ acquired their P. aeruginosa from their water outlets in the intensive care unit. Extensive evidence of transmission was found from the outlet to the patients particularly in the newest hospital, which had the highest rate of positive outlets. The overall findings suggest that water outlets are the most likely source of P. aeruginosa nosocomial infections in some settings, and that widespread introduction of control measures would have a substantial impact on infections. Garvey showed a photo of a sink with paper towels on the floor, surrounding the area, to demonstrate just how far water is dispersed in the room, as well as an image of a water droplet on impact – highlighting the potential spread and trajectory of waterborne pathogens in aerosols. Garvey went on to explain how can we tackle the risk of Pseudomonas aeruginosa, from an engineering perspective, highlighting a paper co-authored with Christina Bradley, among others, which looked at possible interventions on a critical care unit. Water sampling undertaken on the ICU indicated 30% of the outlets were positive for P. aeruginosa at any one time. Molecular typing of patient and water isolates via Pulsed Field Gel Electrophoresis suggested there was a 30% transmission rate of P. aeruginosa from the water to patients on the ICU.
When healthcare practitioners undertake their degrees, how much training do they have around cleaning and its importance – particularly around the science and the reasons why we do what we do? Cleaning is a science and we’re trying to get people’s attention. But how much do we teach people on the fundamentals? Dr. Mark Garvey, consultant clinical scientist in microbiology.
From February 2014, QEHB implemented engineering interventions, consisting of new tap outlets and PALL point-of-use filters; as well as holistic measures, from February 2016, including a revised tap cleaning method and appropriate disposal of patient wastewater. Breakpoint models indicated the engineering and holistic interventions resulted in a significant (p<0.001) 50% reduction in the number of P. aeruginosa clinical patient isolates over a year.9
Garvey pointed out that
appropriate management of water, including both holistic and engineering interventions, is needed to stop transmission of P. aeruginosa
from water to patients. The disposal of patient wastewater, cleaning of tap outlets, and cleaning of medical equipment all need to be considered, along with engineering solutions. “We had three patients who had central line infections involving P. aeruginosa. When we looked at this, they all had the same type. The tap in the IV prep room did not have a Pall filter and the infusion therapy procedure trays were being washed in the water… This shows the importance of teaching staff about cleaning,” Garvey explained.10 Garvey further highlighted new guidelines on automated room decontamination
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