HEALTH AND SANITATION 31 ii . Haemophilus influenzae , ampicillin-resistant iii . Shigella spp ., fluoroquinolone-resistant
4 . CDC : Burden of waterborne pathogens study . Provision of safe drinking water in the United States is a great public health achievement . However , new waterborne disease challenges have emerged ( for example , ageing infrastructure , chlorine-tolerant and biofilm-associated pathogens , increased recreational water use ). Comprehensive estimates of the health burden for all water exposure routes ( ingestion , contact , inhalation ) and sources ( drinking , recreational , environmental ) are needed . We estimated total illnesses , emergency department ( ED ) visits , hospitalisations , deaths , and direct healthcare costs for 17 waterborne infectious diseases . About 7.15 million waterborne illnesses occur annually ( 95 % credible interval [ CrI ] 3.88 million-12.0 million ), resulting in 601 000 ED visits ( 95 % CrI 364 000-866 000 ), 118 000 hospitalisations ( 95 % CrI 86 800-150 000 ), and 6 630 deaths ( 95 % CrI 4 520-8 870 ) and incurring USD3.33- billion ( 95 % CrI 1.37 billion – 8.77 billion ) in direct healthcare costs . Otitis externa and norovirus infections were the most common illnesses . Most hospitalisations and deaths were caused by biofilm-associated pathogens ( nontuberculous mycobacteria , Pseudomonas , Legionella ), costing USD2.39-billion annually .
5 . CDC study of the sources of Legionella outbreaks had some interesting findings : a . Potable water was the most frequent source of exposure ( 56 %), followed by cooling towers ( 22 %) b . Potable water sources accounted for 67 % of healthcare – associated outbreaks ( hospitals and long-term care facilities ) c . Healthcare-associated outbreaks are larger and result in more deaths
6 . According to the CDC : Patients in US hospitals get about 1.7 million HAIs each year . a . 5 % of HAIs are caused by construction .
It is for the above reasons that the American Medical Association stated : “ Perhaps the most overlooked , important , and controllable source of nosocomial infections is hospital water .”
Neither of my former classmates were aware of these studies and were interested in reading more . The lesson here is that there is an opportunity for the plumbing industry to elevate our profession through education . And not just scientific education , but economic education . Preventing waterborne pathogen outbreaks in hospitals can be a boon for healthcare facilities that typically have profit margins of only 5-10 %. Plumbing can be a large part of the solution in helping the healthcare sector provide better care .
Likely because of the above information , the Joint Commission re-issued its New Water Management Requirements notification , which became effective from January 1 , 2022 . These new requirements indicate that the hospital manages risks associated with its utility systems and that the hospital has a water management programme that addresses Legionella and other waterborne pathogens . The science on designing , constructing , and maintaining plumbing systems to prevent WBP outbreaks in many respects is still emerging . There is a lot for professionals to consider during the construction process . The CDC Guidelines for Environmental Infection Control in Health-Care Facilities offer much to consider . Specifically , the guidelines , Part I , Background Information : Environmental Infection Control in Health-Care Facilities , provides a comprehensive review of the relevant scientific literature . Attention is given to engineering and infection-control concerns during construction , demolition , renovation , and repair of healthcare facilities . Use of an infection-control risk assessment is strongly supported before the start of these , or any other activities expected to generate dust or water aerosols . In addition to CDC guidelines , there are a host of other pathogen considerations for healthcare renovation or addition projects ( or even greenfield ): 1 . The two most common pathogen concerns during construction activity are Aspergillus and Legionella . 2 . Infection Control Risk Assessments ( ICRA ) can be used to control the spread of infectious pathogens and material during construction .
3 . Sanitary drain , waste and vent systems should be considered a high risk for exposure to organic pathogens , micro-organisms , bacteria , amoebas , and other potentially infectious material . Appropriate personal protective equipment and precautions should be used when working in potentially hazardous locations to protect workers and building occupants .
4 . Stagnant domestic or process water lines that have not been flushed in more than seven days , or demolition of tanks or equipment where aerosols or exposure to the contents can occur in any building type or location , should be considered a high risk for exposure to organic pathogens , micro-organisms , bacteria , amoebas , and other potentially infectious material .
5 . Using engineering controls and modifying how we work can minimise the generation of dust . Examples of engineering controls and work practice modifications : a . Mist edges of ceiling tiles before lifting . b . Use a containment barrier . c . Use HEPA vacuum attachment when drilling or cutting . d . Use hand tools instead of power tools . e . Use a sweeping compound if sweeping is necessary . f . Perform work in a staging area outside of ICRA environment .
6 . There are many different types of barriers used as part of the ICRA precaution : a . Mobile containment cubes b . Temporary / soft-wall systems c . Hard-wall systems
7 . Considerations for selecting a barrier include : a . Duration of the work task . b . Amount of dust generated . c . Local fire codes .
8 . Other plumbing considerations : a . Recent evidence indicates sinks and other drains , such as toilets or hoppers , in healthcare facilities can become contaminated with multidrug-resistant organisms ( MDROs ). These pathogens can stick to the pipes to form biofilms , which allow the organisms to persist in drains for long periods of time and are often difficult or even impossible to fully remove . Because different types of bacteria may contaminate the same drain , drains can serve as sites where antibiotic-resistant genes are transferred between bacterial species .
Patients may be exposed to organisms in drains when water splashes from the drain . Splashes may occur when water flow hits the contaminated drain cover or when a toilet or hopper is flushed . Splashes can lead to dissemination of MDRO-containing droplets , which in turn may contaminate the local environment or the skin of nearby healthcare personnel and patients . PA
We continue with Part 2 in August issue
June 2022 Volume 28 I Number 4 www . plumbingafrica . co . za