According to David Graham of the Scottish National Blood Transfusion Service (SNBTS), “the importance of the safe diagnosis and treatment of patients cannot be overstated – yet the role played by water quality in patient safety has sometimes been under-stated”.
David Graham was speaking at a one day Pall Medicalsponsored meeting on the prevention and control of healthcare-associated waterborne infections in healthcare facilities held in Edinburgh earlier this year. David Graham, other speakers, and the chair, Consultant Microbiologist and Infection Prevention and Control Doctor for NHS Grampian, Dr Anne Marie Karcher, stressed that good quality water is essential in healthcare premises to prevent the potentially catastrophic consequences of contaminated water for some patients. Susan Pearson BSc reports.
Several speakers at the event referred to the high levels of Pseudomonas aeruginosa found in the water systems of the neonatal intensive care unit (NICU) at the Norfolk and Norwich University Hospital in March, which may have been responsible for the colonisation of three babies with the organism. Fortunately, none of the Norwich NICU babies developed a clinical infection, but others in Northern Ireland were not so lucky. In Londonderry, a baby died in December 2011 as a result of a Pseudomonas infection, and there were three further neonatal deaths at a Belfast hospital in January. In all these cases, the NICUs’ water systems were found to be contaminated with the organism. The Northern Ireland incidents resulted in guidance on Pseudomonas being updated in March of this year. The incidents firmly establish the potential role of contaminated hospital water in the transmission of Pseudomonas to patients. These bacteria inhabit most moist environments due to their ability to form ‘biofilm’, allowing them to attach to inanimate surfaces. This latest ‘official’ guidance emphasises the importance of water monitoring through regular sampling, risk assessment, best practice hand hygiene, and, in some cases, the use of point-of-use (POU) filters to provide bacteria-free water.1 While healthy individuals are not at risk from Pseudomonas, the elderly, babies, and those with compromised immune systems and other predisposing factors, such as wounds and burns, and points of entry for catheters or ventilation tubes, who may be exposed while being washed, are all vulnerable to potentially lethal infections. Other waterborne organisms, in particular Legionella, are also equally dangerous for this group of hospital patients.
Water testing in healthcare premises
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