Infection prevention
Should we have less sinks in hospitals?
The infection risk posed by water systems in hospitals was high on the agenda at the Infection Prevention annual conference. Should we ‘blindly follow guidance’ or take a risk-based approach to water / wastewater safety? Moreover, should we reduce the number of water outlets in hospitals or eliminate them altogether in some locations? Top experts gathered to answer these key questions, at the ICC, Birmingham.
Concerns over waterborne infection risks in UK hospitals have hit the headlines over the past decade. Pseudomonas bacteria was found in the water systems of Belfast’s new state-of-the-art maternity hospital1
; 21 patients were infected
by bacteria in the water supply at the Royal Papworth hospital,2
and an infection outbreak in
the child cancer wards at the Queen Elizabeth University Hospital, Glasgow, is also believed to have originated from the hospital’s water systems.3 These are just some of the high-profile
incidents reported in the national press - demonstrating the need for greater consultation with Infection Prevention and Control (IPC) teams, as well as further specialist training with regards to the built environment. During the conference, speakers highlighted the need for a better understanding of the risks posed by water systems and wastewater, across all stakeholders responsible for designing, building and commissioning hospitals. ‘Blindly following guidance’ is not enough to mitigate the
risks, they warned. During the conference, delegates heard from
Dr. Michael Weinbren, a Specialist Advisor in Microbiology to the New Hospitals Programme, who gave an insight into some of the outbreaks that have been found to have originated from hospital water / wastewater systems – including new builds. He pointed out that the first requirement for a hospital is that it “should do no harm”; patient safety should be “front and centre”. While guidance is important, when it comes to the design, construction and commissioning of hospital facilities, “blindly following guidance can prove very dangerous,” he warned. He gave the example of the guidance for ‘six-monthly water testing for Pseudomonas’ – bacteria can appear between testing regimes over this period, so following this guidance could lead to a failure to identify and act rapidly on any emerging threats. In fact, the risks of waterborne infection
have been well documented, since the 1976 Legionnaires’ disease outbreak in Philadelphia. However, the issue has gained significant
attention in the UK, in the past decade, following an outbreak of Pseudomonas aeruginosa, which claimed the lives of three babies at Belfast’s Royal Jubilee Maternity Hospital, in 2012. There is now a national action plan and, in
recent months, we have seen the publication of the NHS Estates Technical Bulletin (NETB) No.2024/3, which looks at ‘Designing safe spaces for patients at high risk of infection from nontuberculous mycobacteria and other waterborne pathogens’ (27 August 2024). “If you can prevent transmission in the first place, it’s much better than antimicrobial stewardship,” he commented. Dr. Michael Weinbren added that the AMR national action plan is a “step forward”, as it calls for designers, architects, engineers, and facilities managers to work with IPC teams to deliver facilities, so that IPC needs can be anticipated. However, not everyone in infection prevention has been trained in the built environment. If people don’t know the answers, they need to be able to speak up and we need to train people, he asserted. He went on to highlight some of the risks
posed by water outlets and wastewater, as well as a possible solution developed to address the risks associated with shower drains, with a removable and autoclavable shower insert, designed to prevent patients having direct contact with wastewater. “We need to think about the design of showers in the future,” he asserted. Dr. Michael Weinbren went on to highlight
research by Fucini et al which showed that, when ITU rooms have a sink located within them (as opposed to outside), this can result in an increased rate of Pseudomonas-associated infection.4
Approximately 5% of patients, in a
study by Halstead et al, ‘definitely’ acquired their P
. aeruginosa from their water outlets in the
intensive care unit.5 Sinks have the potential to “harm and kill
March 2025 I
www.clinicalservicesjournal.com 35
Dr_Microbe -
stock.adobe.com
t
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64
