Numerous healthcare-associated infections (HAI’s) have been linked to contaminated water used for patient care. Waterborne infections are often not the top priority in healthcare facilities, however a waterborne disease outbreak could have serious consequences for the patients it effects, especially in high risk areas such as ICU.
Following an infection outbreak in two cancer wards at the Queen Elizabeth University Hospital in Scotland, an investigation took place which showed the outbreak was linked to bacteria in the water supply1. This is not a standalone incident, there are hundreds of similar cases where healthcare facilities have experienced a HAI outbreak as a result of contaminated water supplies.
Water supplies to healthcare facilities are frequently overlooked as a source of infection, yet can harbor many dangerous p athogens that threaten patient safety2. One of the most common of these is Legionnaires disease, a dangerous lung infection that shows resistance to many common antibiotics4. Tim Keane, consultant for Environmental Infection Control stated that “hospitals are by far the most at risk for legionella outbreaks of any building”5; in fact, a recent survey showed that 75% of hospitals had the Legionella bacteria in their water system8.
Of course, no water supply is completely uncontaminated, and water in hospitals is never expected to be pathogen free, however inspections often find that hospital water surpasses safe pathogen levels11. This can consequently have a detrimental effect on immunocompromised patients, who have less resistance to infection than most healthy individuals.
Causes of Waterborne Diseases
Contamination of hospital water usually occurs within the infrastructure of healthcare facilities, when pathogens that enter the drains stick to the pipes, forming biofilms which allow the organisms to live for long periods of time3. Recommendations are provided for hospital plumbing construction, to ensure that stagnation can not occur within the pipes, however many hospitals predate these recommendations and the complex structures of their plumbing systems mean there is a high risk of water stagnation and deadly bacteria developing5.
Patients can be exposed to these bacteria through both ingestion and contact with contaminated water11. There are a wide variety of ways that a patient can be exposed to contaminated water, these include:
- Bed baths
- Flower vases
- Eyewash station
- Washed linens
- Air conditioning units
Prevention of Waterborne Diseases
Waterborne pathogens can have a significant financial burden on hospitals, with the cost of treating each HAI estimated at over £3,000 per patient in the UK7. In addition to increased costs, each infection also means additional use of nurse time, greater patient discomfort and a decrease in patient safety7. It is therefore crucial that hospitals and healthcare facilities consider ways to reduce the risk of outbreak.
A study undertaken in five ICUs found that the removal of sinks from patient rooms and introduction of a method of completely ‘water-free’ patient care was associated with a significant reduction of patient colonization with potentially harmful bacteria10. Whilst eliminating patient contact with hospital water entirely might be unfeasible, there are small changes that healthcare facilities can implement to control the risk of exposure to contaminated water9.
One solution is replacing the traditional bed bathing practice of using a bowl of soap and water, with a waterless bed bathing solution. Vernacare offer Oasis bedbath wipes, an ideal alternative for patient bathing. The Oasis waterless bathing wipes are pre-impregnated with skin cleansers to gently bathe the patient and provide immediate and long lasting moisturisation. The wipes are then disposed of after use to help reduce the potential for cross-contamination.
There are also other possibilities for limiting patient’s exposure to hospital water including replacing tap water with bottled water and introducing waterless agents for hand washing.