Ruth Wozencroft of CRJ Key Network Partner, Q-bital Healthcare Solutions, tells us that on the face of it, the answer is simple – clean air and clean water.
In countries such as the UK, we assume that the water we use is hygienic and fit for human use and that the air we breathe, in most areas, is perfectly safe. However, sometimes it is not that simple and this is when it can get dangerous. Image: neyro2008|123rf
It’s never more important to maintain air and water quality than in a healthcare environment. They are places where people are vulnerable – some are very sick, or they may have compromised immune systems, be very young or elderly, or may have open wounds – which makes them more susceptible to the bugs which could be carried in imperfect water or air systems.
Therefore, it’s important to recognise that providing care for the sick and injured goes beyond providing medical and surgical treatment; hospitals and healthcare organisations must provide a safe, clean and comfortable environment for patients, visitors and staff and this includes the water and air.
Water, water everywhere…
Maintaining a consistent supply of clean, reliable water for drinking, washing and bathing as well as providing water for specific medical processes (including the vital aspect of instrument cleaning and sterilisation) and for machinery, heating, cooling and cleaning is key. But microbes can lurk in water and they can be deadly.
Water is prone to bacterial growth when it enters a building's plumbing. Biofilm, also known as 'slime', is an aggregate of micro-organisms that provides a home for bacteria to grow and multiply. Legionella is probably the most well-known but disease-causing (pathogenic) bacteria also include Pseudomonas aeruginosa, Helicobacter pylori, E. coli and Mycobacteria avium. All are potentially very dangerous and aren’t necessarily ‘caught’ through drinking water – in fact, bacteria can be inhaled in droplets while showering, brushing teeth or washing – all activities which take place regularly in healthcare environments.
In November 2017, an outbreak of Legionnaires' disease occurred in São Francisco Xavier Hospital, in Lisbon, Portugal. The outbreak resulted in 56 confirmed cases of Legionnaire's disease, of which six died. The ensuing investigation traced the source of the infection to a cooling tower in the hospital. Over the decades, there have been many examples of water-borne bacteria causing illness and fatalities in hospitals across the world.
Water management programmes in healthcare facilities are an important way to help protect vulnerable patient populations as well as staff and visitors. Every use of water must be scrutinised and evaluated for its risk to harbour and transmit healthcare-associated pathogens
Patient safety depends on ensuring that:
- water entering a healthcare facility meets all applicable quality standards;
- plumbing (ie a building’s hot and cold-water piping systems) is designed and maintained in a way that minimises growth and spread of waterborne pathogens in both the supply and waste sides; and
- exposure to infection risks from water sources is minimised
Healthcare facilities have large complex water systems that can promote the growth of pathogenic organisms if they are not properly maintained. They must have effective water management programmes to limit opportunistic pathogens from growing and spreading. These require input from multidisciplinary teams that include facility managers, infection prevention professionals, clinicians, and administrators.
Many aspects need to be examined, including system disruptions or pressure drops, low chlorine levels, plumbing (including the age and overall design of the system, additions, renovations and other modifications) and water age (ie how long water might be held in the piping system). In addition, there should be no ‘dead ends’ where water can stagnate. The various pathways that might lead to patients becoming exposed to waterborne pathogens, in relation to ingestion, diet, hygiene, and clinical care should be considered and action taken to reduce risk.
But it is not just water that carries risks.
The air we breathe…
Ventilation systems are vitally important in any healthcare establishment. They carry out a number of roles to keep patients, staff and visitors safe and as healthy as possible. Hospitals are places where many sick and injured people are gathered in one space so having high quality, well-filtered air is essential.
Ventilation systems are focused on removing and filtering contaminated air which may include bacteria such as MRSA or Legionella and transmit viral infections which can be devastating if brought into contact with vulnerable patients.
Aside from the bacterial and viral threats, we shouldn’t forget that more benign elements can also have an impact – for example, food cooking smells, or the incinerator dealing with medical waste can also affect the air quality and comfort levels of patients.
Hospitals are under intense scrutiny by the UK Government to abide by strict regulatory standards to ensure the safety and comfort of patients, visitors, and staff – this includes the air around them.
Estates and infection control teams work closely on inspection and maintenance (including cleaning) of ventilation systems within hospitals and they recognise their critical importance. They work together to comply with the strict technical and infection control standards to keep airborne bacteria at acceptable levels and to protect everyone’s well-being.
It is important that work of this nature is planned for, wherever possible. Where it is, Q-bital Healthcare Solutions can work alongside estates teams to help them develop a plan to ensure that there is no dip in capacity or disruption to patient flow if vital patient care or sterilisation areas need to be temporarily closed.