Pseudomonas is a bacteria that is naturally found in both water and soil. This opportunistic and versatile organism can thrive in a wide variety of damp environments. The bacteria can be found on the skin and in large intestine of approx. 50% of humans. The most common type of these bacteria is Pseudomonas aeruginosa, this is of a particular concern within healthcare premises specifically in augmented care units. These Augmented care units are classified High Risk as these patients are severely immunocompromised because of disease or treatment, transplant patients, any patients who have extensive breaches in their dermal integrity and require contact with water – burns units etc. where the results of any infection could prove to be fatal.
Pseudomonas aeruginosa can colonise tap and shower outlets as a result of contaminated water supplies, back splashing during hand washing, inadequate cleaning techniques, inappropriate disposal of bodily fluids and storage of contaminated medical equipment. The majority of Pseudomonas growth occurs within the last 2 meters of distribution pipes prior to, and including the outlet. Outlets often provide a favourable environment for P. aeruginosa to grow through scale and rust, tap inserts (aerators, straighteners, spray heads etc.) and oxygen which allows aerobic respiration. Unlike Legionella, P. aeruginosa can be transferred from person to person by physical contact and back to the environment.
The likely routes of infection are:-
- Contact with mucous membranes or surgical site splashing from water outlets
- Inhalation of aerosols
- Medical devices
- Indirect contact
The Operational Management within each healthcare organisation should be able to demonstrate that they have suitable governance, competence and accountability arrangements in place to deliver safe water in their premises through its WSG (water Safety Group) and WSP (Water Safety Plan)
The correct maintenance of hot and cold water systems is integral for the control of Pseudomonas within a Healthcare environment. It is important that patients are supplied with microbiologically safe water at all times and this can be achieved by effective management and operation of the water supply and delivery systems.