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by Sarah Bailey MSc PGDip Med Myc
Principal Consultant
Although most legislation and advice concentrates on the production of a Water Quality Management Plan (WQRMP) for just Legionella, Pseudomonas aeruginosa could be responsible for a much higher burden of disease, and should always be included in a risk management plan1.
P. aeruginosa is a Gram-negative bacterium, that can live in potable water and other damp areas such as drains and damp cloths. They can thrive in water with low levels of nutrients and are commonly found in the hospital environment – even in disinfectant solutions.
It can cause a variety of infections from bloodstream infections, otitis media and externa, conjunctivitis, soft tissue infections and may others. It is a particular issue for burns patients, patients with impaired immune systems, Bone Marrow Transplant and cystic fibrosis patients 2.
P. aeruginosa is an important cause of morbidity and mortality in the hospital setting. Infections can also be very hard to treat as the number of effective antibiotics are limited. Treatments can often have to be intravenous, and can increase the length of stay considerably. Controlling pseudomonas in water on one ward saved one hospital $22, 772 on meropenem alone in a year 3.
P. aeruginosa also produces a sticky polysaccharide or sugary matrix from the cells, which allows it to stick to and establish a biofilm on taps, outlets and equipment. This helps to make it very resistant to chlorine and other disinfectants and cleaning methods, and allows it to spread along tap outlets and in drains.
P. aeruginosa is found in a large variety of environments in the hospital such as tap fittings, showers, spa baths, swimming pools, cleaning cloths & mops, standing water, sinks and drains.
It is nearly always present in the drains of sinks and this can be an important source in contamination of sinks and hands from the drain, usually due to inadequate cleaning methods where the basin of the sink is cleaned before the outlet.
In a tap fitting, pseudomonas is usually found in the tap itself and the pipework immediately behind the tap, and not usually colonising the water supply in the hospital system pipework.
Studies in the UK after an outbreak in Belfast have shown that the more complex the internal structure of the tapware, the more likely the outlet will be colonised with Pseudomonas aeruginosa4. Sensor taps can be particularly complex and prone to colonisation.
It can also survive in disinfectant solutions if these are not changed regularly, and use of colonised solutions can contaminate large areas of surfaces with P. aeruginosa if they are used for cleaning.
Adding Pseudomonas aeruginosa to the WQRMP is essential in any healthcare facility if risk is to be properly managed.
Input from all relevant parties such as clinical, facility and cleaning staff should be sought so that a holistic plan that is achievable can be produced.
Training should also be available to staff, especially cleaning staff so that the requirements of the management plan can be achieved.
Control of pseudomonas should be included in any water management plan produced for a hospital or aged care home.
Control of pseudomonas can be complex, and training and knowledge is the key. Some points to consider are:
Excellent advice and background can be obtained from a consultant specialising in hospital water quality, and from the UK Health Departments “HTM 04-01 Part C: Pseudomonas aeruginosa – advice for augmented care units”. This contains advice on management for patients who are immunosuppressed, transplant patients, critical and intensive care units and patients whose dermal integrity is breached 2.
The published report on the investigation in to the deaths of several babies in a Belfast hospital due to Pseudomonas aeruginosa also has plentiful information on issues to consider when controlling this organism 4.
1. Bedard E, Prevost M, Deziel E (2016) Pseudomonas aeruginosa in premise plumbing of large buildings. Microbiology Open 2016 5:937-956
2. Department of Health UK (2016) Health Technical Memorandum 04-01: Safe water in healthcare premises. Part C: Pseudomonas aeruginosa – advice for augmented care units.
3. St Georges Hospital (2010) Loveday, C; Decker, V and Newton, S. Point of use filters: costly or effective?
4 Health Protection Agency UK (2012) Investigation of Pseudomonas aeruginosa on biofilms in water tap assemblies from neonatal units in Northern Ireland. Dr Jimmy Walker et al.
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