Infection prevention
Importance of detecting pathogens in water
A recent trial has highlighted the value of water testing for the early detection of infection outbreaks, to enable health and care providers to implement robust infection prevention measures. However, water testing can offer a valuable contribution to IP&C in a variety of ways – from epidemiology and environmental monitoring, to ensuring the safety of medical devices.
Early detection of pathogens through water testing strategies can offer valuable insights into potential threats. Wastewater-based epidemiology (WBE) has had an important role in monitoring risk from pathogens for many decades but there has been a renewed focus in recent years. Most recently, the UK Heath Security Agency (UKHSA) and Medicines and Healthcare products Regulatory Agency (MHRA) found poliovirus in sewage samples collected from treatment works in the London area, providing an early indication of person to person transmission in the UK. As part of routine surveillance, it is normal for
1 to 3 ‘vaccine-like’ polioviruses to be detected each year in UK sewage samples but these have always been one-off findings that were not detected again. These previous detections occurred when an individual vaccinated overseas with the live oral polio vaccine (OPV) returned or travelled to the UK and briefly ‘shed’ traces of the vaccine-like poliovirus in their faeces. Further investigations have been taking place
after several closely-related viruses were found in sewage samples taken between February and May 2022. The virus has continued to evolve and is now classified as a ‘vaccine-derived’ poliovirus type 2 (VDPV2), which on rare occasions can cause serious illness, such as paralysis, in people who are not fully vaccinated. The detection of a VDPV2 suggests it is likely
there has been some spread between closely- linked individuals in North and East London and that they are now shedding the type 2 poliovirus strain in their faeces. Following these initial findings, the UKHSA and MHRA has since taken the decision to expand surveillance to a range of areas outside of the capital. However, WBE could have much wider applications in infection prevention and control than this type of epidemiology. According to the latest research, it could provide an early warning for hospitals, care homes, mental healthcare providers and prisons, enabling measures to be
put in place to reduce transmission of norovirus, SARS-CoV-2, influenza and other pathogens. Routine testing of water could provide an important role in keeping populations safe. One UK laboratory has been making inroads in this area and has been conducting trials to understand how quantitative reverse transcription PCR (RT-qPCR) could contribute to infection prevention efforts in health and care settings. At the start of the pandemic, 20/30 Labs made the decision to build on existing molecular capability to support the national response to the control the spread of SARS- CoV-2. Zoë Laughton, managing director, 20/30 labs, explained how the laboratory quickly adapted to the evolving situation: “Prior to the pandemic, a lot of our testing business was within endoscopy departments, evaluating the quality of final rinse water. However, lots of elective procedures were postponed during this period, which reduced the need for endoscope reprocessing. At the same time, there was a growing National demand for testing of COVID. Within six weeks, the company
raised funds to set up a (UKAS accredited) COVID lab to undertake not for profit testing.” In 2020, the Department of Health and Social
Care (DHSC) approved 20/30 Labs as one of the select few private and independent laboratories to be listed as a supplier for a full range of screening testing for novel Coronavirus (SARS- CoV-2) by RT-qPCR. “At the time, the only testing available was in hospitals, but the testing provided by 20/30 Labs made the service accessible to other healthcare settings – such as GP surgeries, care homes and mental healthcare providers. During the pandemic, we were processing over 15,000 samples per week. Having gained a reputation in this area, we moved on to commercial testing. It changed our business model and allowed us to purchase new equipment, such as the MALDI-TOF, for our environmental water laboratory and invest in innovation in areas such as wastewater.” Laughton explained that although WBE has
been around since the 1970s, when it was used to test for polio, it isn’t an approach that has
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