Controlling Pseudomonas outbreaks

Published on Friday, 07 September 2012 09:47
Posted by Scott Buckler

The Department of Health has published a report relating to a review of the scientific evidence regarding the contamination of hospital water supplies and outlets with Pseudomonads

This information was considered by the Chief Medical Officer, Professor Dame Sally C Davies, in August 2011 and this report reflects information available at that time.

Download the Report on the review of evidence regarding the contamination of wash-hand basin water taps within augmented care units with Pseudomonads (PDF,265K)

The output from the review exercise helped inform the development of the Department of Health's action plan and programme of work to address Pseudomonas contamination of water sources and water systems.  This led to the production of new infection control advice and technical guidance, which was issued earlier this year.

The report reveals that, while the long-term impact is unknown, trusts that have replaced infrared non-touch taps with traditional elbow or knee-activated devices have seen an end to Pseudomonas contamination for at least the reported period. The typical bill for replacing all non-touch taps in a standard large NHS intensive care unit is estimated at around £2,500 per unit, with a £50,000-a-year running cost.

This finding has led to calls for suppliers to consider a redesign of healthcare tap and water systems, including the possible use of new materials.

The report states: “Manufacturers should be encouraged to seek alternative designs that reduce the risk by minimising the use of materials, including a reduction in surface area, that may release utilisable carbon {which bacteria requires to grow} and by designs that do not leave residual volumes of water and will withstand a higher level of chemical and heat disinfection.”

It adds: “If the evidence of a connection between contamination and biofilm build-up is seen as persuasive then biofilm suppression may be a relevant factor. This has implications for the design and choice of materials used in tap construction and pipework fabrication.”

Manufacturers should be encouraged to seek alternative designs that reduce the risk by minimising the use of materials, including a reduction in surface area, that may release utilisable carbon and by designs that do not leave residual volumes of water and will withstand a higher level of chemical and heat disinfection

The working group also explored the impact of control measures such as UV water treatment, high-temperature flushing, and chlorination, finding that while there was evidence they had an impact on the presence of bacteria, their long-term success rate was largely unknown. It did, however, find that, in a large number of reported cases of Pseudomonas the colonisation occurred within the last 1.5-2m of the plumbing system nearest to the tap outlet and rarely extended beyond 1m from the tap. Additionally the key problems seem to stem from residual water present within the pipework when the tap was closed.

The Department is currently undertaking additional work to inform the development of an addendum to the existing Estates guidance, Health Technical Memorandum 04-01: The control of Legionella, hygiene, "safe" hot water, cold water and drinking water systems  to address issues relating to Pseudomonas aeruginosa. This is expected to be available March 2013.

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