Infection prevention
there will be winter pressures through upsurges in COVID and influenza, but it doesn’t know where. Some geographical areas will experience larger outbreaks – having some foresight into this would enable decisions to be made to reduce the impact,” she continued. Jenn Stevenson, clinical development manager, 20/30 Labs, added that wastewater testing can be implemented anywhere and be used to detect more than just pathogens – it can provide analysis of other indicators relating to healthcare protection – such as the use of narcotics, for example.
“In prisons, you can hone in on a wing, a department or a whole building using WBE,” she explained.
Mycobacteria test In addition to wastewater analysis, 20/30 Labs has also developed a molecular mycobacteria test. Mycobacterial infections can cause tuberculosis or nontuberculous mycobacteria (NTM) pulmonary infections, for example. The 20/30 Labs MycoAssure PCR test produces a result in 6 hours, as opposed to standard 4-6 week agar tests, enabling a much faster response. Mycobacterial tests are required for final rinse water in endoscopy units and this test speeds up the process significantly. Rapid mycobacterial detection by PCR is also proving valuable in detecting and sequencing strains of pathogens, such as Mycobacterium chimaera, which have been linked to infections in cardiac patients through the use of cardiac heater/cooling devices. Currently, there is no established therapy for patients who contract an invasive Mycobacterium chimaera infection and the case-fatality rate is around 50%, highlighting the importance of hospitals remaining alert to potential sources of contamination.1-3
Water sampling for waterborne pathogens Detection of waterborne pathogens in hospital water systems is also vital – while ageing buildings with poorly designed infrastructure can present increased risks of contamination, some high-profile incidents have also been reported in newly built hospitals. For example, at the Queen Elizabeth University Hospital, Glasgow, an outbreak of infection linked to the hospital’s water systems led to unnecessary infections and mortality on a children’s cancer ward. Between the period of 29 January and 26 September 2018, 23 cases of blood stream infections (11 different organisms) with organisms potentially linked to water contamination were identified. Following the closure of wards and other
facilities (such as during the pandemic or building works), vigilance is also required. The enforced shut down and stagnation of water systems can create ideal growing conditions for a range of harmful bacteria. Water sampling is therefore vital to ensure that bacteria and biofilms have not accumulated in water systems, prior to facilities reopening for public use.
Under the Health & Safety at Work Act
1974, there is also a duty of care in the UK to perform routine analysis of water samples for the presence of Legionella, a group of organisms that cause pneumonia-like illnesses particularly in those that are elderly or immunocompromised. 20/30 Labs is registered with the Legionella Control Association for Analytical Services. Pseudomonas aeruginosa is another
environmental bacterium found in water. To the majority of people, it is harmless. However, in healthcare settings, it must be controlled due to its inclination to infect the
immunocompromised and cause nosocomial or healthcare-acquired infections (HCAIs). The Health Technical Memorandum (HTM) 04-01 Safe Water in Healthcare Premises and HTM 01-06 Management and Decontamination of Flexible Endoscopes detail the requirements for the sampling, methods of analysis and remediation of Pseudomonas aeruginosa in water in various settings, including healthcare settings and public buildings. To minimise the risk of waterborne infection, 20/30 Labs provides microbial analysis of water sources, including: Total Viable Counts (TVC),
E.Coli/Coliforms, Pseudomonas spp., and Legionella spp. The laboratory currently has the capacity for 20,000 SARS-CoV-2 RT-qPCR samples per week, 2,500 wastewater samples per week (which can be increased if required) and 10,000 environmental samples. It can provide in house RT-qPCR, whole genome sequencing, MALDI-TOF, chemical analysis, microscopy, food microbiology to detect food borne pathogens, and offers decontamination consultancy on cleaning efficacy – including protein residue found on surgical devices. “We are moving forward with some ground-
breaking infection detection services,” Stevenson commented. “We are much more than just a test result,” she concluded. Ultimately, a multimodal approach to
detection of pathogens across health and care settings can enable better preparedness, improve infection prevention, and help identify escalating risk from pathogens of concern. Cost effective and rapid methods of water analysis have a key role to play in supporting IP&C initiatives.
CSJ
References 1 Sommerstein R, Hasse B, Marschall J, Sax H, Genoni M, Schlegel M, Widmer AF; Swiss Chimaera Taskforce. Global Health Estimate of Invasive Mycobacterium chimaera Infections Associated with Heater-Cooler Devices in Cardiac Surgery. Emerg Infect Dis. 2018 Mar;24(3):576-578. doi: 10.3201/eid2403.171554. PMID: 29460746; PMCID: PMC5823345.
2 Walker J, Moore G, Collins S, Parks S, Garvey MI, Lamagni T, et al.Microbiological problems and biofilms associated with Mycobacterium chimaera in heater-cooler units used for cardiopulmonary bypass. J Hosp Infect. 2017;96:209–20. 10.1016/j.jhin.2017.04.014
3 Sommerstein R, Schreiber PW, Diekema DJ, Edmond MB, Hasse B, Marschall J, et
al.Mycobacterium chimaera outbreak associated with heater-cooler devices: piecing the puzzle together. Infect Control Hosp Epidemiol. 2017;38:103–8. 10.1017/ ice.2016.283
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