Pseudomonas – an opportunistic foe

Harnessing the expertise of a multidisciplinary team, encouraging all staff to ‘go the extra mile’ preventatively, and above all, ‘going beyond compliance’, was provided by George McCracken, head of Estates Risk and Environment at the Belfast Health and Social Care Trust – in whose Royal Jubilee Maternity Hospital three young babies died after an outbreak of the bacteraemia in early 2012 – at a recent Water Management Society conference. HEJ editor, Jonathan Baillie, reports.
The one-day conference, Preventing Pseudomonas – some lessons learned – held at the Tower Suite at Drayton Manor Park near Tamworth on 3 December – took place at an apposite time, with the spotlight on healthcare water hygiene and safety having been particularly intense over the past 18 months, largely on the back of the extensive media coverage of the Pseudomonas aeruginosa outbreaks in the neonatal intensive care units (NICUs) at Belfast’s Royal Jubilee Maternity Hospital (RJMH) and Londonderry’s Altnagelvin Hospital in late 2011 and early 2012 (HEJ – March, May, and June 2012). The Department of Health subsequently released an Addendum to the existing HTM 04-01, The control of Legionella, hygiene, ‘safe’ hot water, cold water and drinking water systems, entitled Pseudomonas aeruginosa – advice for augmented care units, while the Health and Safety Executive (HSE) is in the process of publishing a revised version of its ‘L8’ Legionella Approved Code of Practice and guidance.

Dealing with the aftermath

One of the conference’s many topical presentations was given by George McCracken, of the Belfast Health and Social Care Trust, who faced the extremely difficult task of dealing with the immediate aftermath of the Pseudomonas outbreaks in the Trust’s hospitals from an estates engineering standpoint. This not only required him to answer searching questions – under great pressure, and within days of the January 2012 outbreak at the RJMH Belfast NICU which saw the fatalities – on what measures he and his team intended take to stop further colonisation and transmission of P. aeruginosa, but also to try to identify, in tandem with HSE and Public Health Agency investigators, the outbreak’s source. George McCracken began his address, ‘The Belfast Experience’, by explaining that the Trust has a £1.2 billion budget, 20,000 staff, and an 800,000 m2 estate; its sheer scale – ‘a huge wheel to try to turn’ – being ‘one of my team’s biggest challenges’. In 2009, he explained, a Legionella outbreak on one of the Trust’s neurology wards had seen two patients contract Legionnaires’ disease. This incident further strengthened the Trust’s ‘already committed focus’ on water hygiene and safety. George McCracken said: “The Trust’s Water Safety Group was established in the aftermath of the Legionnaires’ incident, and this provided great help in managing Pseudomonas.”