26-Jan-2012

Contaminated taps to blame for UK Pseudomonas outbreak

Three babies have died from the Pseudomonas outbreak at the Royal Jubilee Maternity Hospital in Northern Ireland

The outbreak of a deadly bug that killed three babies in a neonatal unit in Belfast could have been prevented, according to industry experts. After Northern Ireland health minister, Edwin Poots confirmed that the infants who died at the Royal Jubilee Maternity Hospital (RJMH) had tested positive for the Pseudomonas bacteria, industry leaders suggested more could and should have been done to monitor water systems and pipework, a known breeding ground for the bug.

Poots confirmed that Pseudomonas had been found in a number of taps in the intensive care area of the hospital. “Pseudomonas is present in many natural environments, including soil and water. It can be found in sinks, taps and water systems and can be difficult to eradicate,” he said in a statement.

“I can report that investigations so far have shown the Pseudomonas bacteria have been found in a number of taps in the intensive care area of the neonatal unit at the RJMH. The trust health estates team are in the process of removing and replacing all taps and related pipework in the affected area.”

He added that no evidence had been found to suggest the bacteria was present in the water system itself.

The statement continued: “Specialist advice has been received from experts in England and action is based on current best available evidence. The unit will only be opened once all remedial work is completed and tests show that it is safe to nurse babies in this environment.”

Water treatment experts have claimed that the situation could have been prevented. One UK water treatment specialist, who asked not to be named, said: “In theory this should never have happened.

“Pseudomonas is perfectly preventable and most hospitals have a very strict regime of chlorination and disinfecting. Either this was not adequate in this case, or the regime was not being followed properly.”

Hospitals pose a particular problem as many buildings are old and the pipework is complex, with multiple deadlegs where water can stagnate.

“It is very difficult to keep the pipework in good condition. It’s a question of doing a proper risk assessment of the entire water system regularly,” the specialist stated. “It could be a problem with the temperature of the water not being high enough, not enough chlorination, inadequate flushing, or a combination of all three.”

Bhartu Patel of Stansted Laboratories added that hospitals needed to ensure they continuously monitor the supply and are vigilant about the decontamination and replacement of plastic devices such as catheters and tubing.

He said: “Hospital estates are very complex and water supplies are often redirected, leaving deadlegs in the system that provide an ideal breeding ground for bacteria. Pseudomonas produces a slime that anchors the cells to the environment, making it particularly difficult to kill. Disinfectant of the pipework alone is not enough. You need to have a continuous dosing system.

“My advice to hospitals in the wake of this incident is to ensure constant testing and monitoring of pipework and fixtures and to be vigilant about the contamination of plastic tubing, which is the ideal environment for the bacteria to take hold and transfer to patients.”

A thorough deep clean has been carried out at the RJMH and the affected taps and pipework are being replaced with ultraviolet technology.

This is not the first time concerns have been raised over the presence of Pseudomonas in UK hospitals. An outbreak at Guy’s Hospital in London in 2005 infected 19 patients and Pseudomonas was confirmed in five children in the paediatric intensive care unit at Glasgow’s Royal Hospital for Sick Children in 2007.

In 2010, the Department of Health issued an alert to NHS trusts across England and Wales following outbreaks stemming from handwash basins at Morriston Hospital in Swansea. The document said: “It is important for ... infection control teams to assess the risk to their patients and where appropriate establish if the water used in hand washing has an unacceptable bacterial count.”

The document also suggested the sink taps could have been colonised after the basins were used for purposes other than hand washing, such as disposing of bodily fluids, and ruled that sinks should be cleaned in a manner that “minimises the contamination of the faucet from organisms in the sink trap (via plug hole or overflow)”. It also called for improved hand hygiene and the installation of point-of-use filters.

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