Page 7 - Water_Controls_for_Healthcare

HOSPITAL
Infection control / SOLUTIONS

PSEUDOMONAS AERUGINOSA MONITORING FOR PSEUDOMONAS
AERUGINOSA
Almost 40% of all cases of Pseudomonas aeruginosa The Department of Health and Social Care (DHSC)
originate while the patient is in hospital care (39%). conducted a study into contamination by Pseudomonas
Pseudomonas aeruginosa, requires 2 elements aeruginosa in mixers/taps and the water supply system.
in order to develop: 3.5 million This study resulted in the publication of technical
- water at a temperature between 4°C and 42°C guidance written specifically for augmented care
(optimal development between 30°C and 37°C). healthcare acquired units. This latter was incorporated in the revised
- the ability to oxidise. infections in Europe of which version of the HTM 04 01 Part B in 2016 which
90,000 outlines what action to take when healthcare
Pseudomonas aeruginosa is transmitted by facilities become contaminated with Pseudomonas
hand by healthcare staff and via infected medical are fatal aeruginosa.
equipment. Invasive surgery presents a high risk Source: European Centre In order to assess the level of water contamination
of transmission of this type of infectious agent. for disease prevention by Pseudomonas aeruginosa, the DHSC recommends
and Control (ECDC)
sampling the first water to be delivered from the outlet.
There are several levels of Pseudomonas aeruginosa Furthermore, to maximise the recovery of free-floating
contamination. bacteria it recommends taking samples:
- at least 2 hours (preferably longer) after the last draw-off
Pseudomonas aeruginosa development at outlets used on a daily basis.
in the spout - on outlets that are used infrequently on a weekly basis,
Pseudomonas aeruginosa primarily contaminates mixer and tap or as indicated in the Water Safety Group’s risk assessment.
spouts, since it needs a mixture of air and water to develop. - The tap should not be disinfected (heat or chemical treatment)
Biofilm, niches and cavities in the spout walls protect or deliberately cleaned prior to sampling.
the bacteria from treatments, and provide the ideal
environment for the bacteria to proliferate. The DHSC has addressed the issue of tap and water
At the outlet, Pseudomonas aeruginosa finds all Almost 40% system contamination by these bacteria.
the necessary conditions to develop and proliferate, The Health Technical Memorandum (HTM 04 01)
establishing permanent colonies in mixers and taps. of Pseudomonas published in 2016, provides guidance on best
Even cleaning spouts and flow straighteners aeruginosa cases originate practice for monitoring and testing for these
regularly is ineffective. while the patient is in hospital two pathogens, and identifying the level of
care contamination in water, to ensure compliance
Pseudomonas aeruginosa development Source: Public Health England 2021 with current regulations.
in flexible hoses and pipework Pseudomonas aeruginosa For Pseudomonas aeruginosa, action is initiated
Once established in the biofilm in mixers and taps, bacteraemia annual as soon as the alert level is reached, that is to say,
figures
Pseudomonas aeruginosa continues to develop above 1 CFU/100mL, as per in France.
and will gradually colonise the flexibles and pipework unless In Germany, in the framework of monitoring for Pseudomonas
an effective solution is put in place. aeruginosa, hospitals and healthcare establishments must test
twice a year. The satisfactory level is 0 CFU/100mL.
By this stage it is impossible to eradicate Pseudomonas
aeruginosa, which then becomes a threat to the entire water
system. Monitoring levels for Pseudomonas aeruginosa:
Satisfactory level < 1 CFU/100mL
Unsatisfactory level > 10 CFU/100mL
CFU/mL: Colony Forming Units/millilitre

In its report the DHSC clearly indicates that disinfecting the water
supply (hot and cold) is insufficient for removing an established
biofilm. It recommends that, where installed, removable taps
should be periodically removed for internal cleaning and
disinfection to remove any biofilm and bacteria residing within.
Healthcare facilities should establish regular cleaning protocols.
See more about DELABIE’s solutions on page 10.

The bacteria that form biofilms on the surface of certain 750,000 infections/year, of which 4,200 were fatal.
materials are responsible for one third of healthcare- The European Centre for Disease Prevention and Control
acquired infections (HCAIs). (ECDC) calculates that HCAIs affect 3.5 million patients every
According to the National Institute for Health and Care year and are responsible for 90,000 deaths annually.
Excellence (NICE, 2023), it is estimated that 300,000 Not forgetting that non-healthcare buildings that are open to
patients in England acquire an HCAI as a result of care within the public are also at high risk. In effect, according to statistics
the NHS. In 2018/19, the prevalence of HCAIs in hospitals in by the French Institute for Public Health Surveillance,
England was 7.5%. 47% of Legionella cases identified in 2019 were linked to
A 2012 study, repeated in 2017, by the French national visits to hotels, tourist accommodation, campsites, swimming
Institution for Health Monitoring (IHM), found that one in pools and sports stadia, compared to 11% linked to
twenty (5%) French healthcare patients contracted an healthcare facilities (hospitals, retirement homes, etc.).
healthcare acquired infection. This represents approx.

Hospital solutions 5