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. 2007 Mar 13:7:34.
doi: 10.1186/1471-2458-7-34.

Experimental based experiences with the introduction of a water safety plan for a multi-located university clinic and its efficacy according to WHO recommendations

Alexander Dyck  1 , Martin Exner, Axel Kramer
Affiliations

Experimental based experiences with the introduction of a water safety plan for a multi-located university clinic and its efficacy according to WHO recommendations

Alexander Dyck et al. BMC Public Health. .

Abstract

Background: Due to the high number of immunosuppressed and other predisposed patients hospitals have to control and ensure the microbiological water quality. The origin for the occurrence of pathogenic microorganisms in water pipes is the formation of biofilm.

Methods: For the permanent control of water safety a water safety plan (WSP) was realized as recommended by the WHO following the principle "search and destroy". The WSP is based on an established HACCP concept due to the special focus. The most important measures include the concept for sample taking depending on patient risk. 3 different categories) are distinguished: risk area1 (high infection risk), risk 2 (moderate infection risk), and risk area 3 (not increased infection risk). Additionally to the threshold value of the German law for the quality of drinking water (TrinkwV) three more limiting values were defined (warning, alert, and worst case) for immediate risk adapted reaction. Additional attention has to be focussed on lavatory sinks, which are an open bacterial reservoir. Therefore continuous disinfecting siphons were installed as part of the WSP in high risk areas. If extended technical equipment is not available, especially for immunocompromised patients the following measures are easy to realize: boiled (or sun exposed) water for nursing procedures as well alimentary use, no showering.

Results: Comparing data over 3 years the microbial water quality was significantly improved resulting in no new case of nosocomial Legionella pneumoniae and decrease in neonatal sepsis.

Conclusion: According to average situations with highly contaminated water system the management must be defined with implementation of water task force, immediate providing of special equipment, information of patients and staff and control of the water quality, an example for successful decontamination of the hospital within 24 hours is given.

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Figures

Figure 1
Figure 1
CP and CCP in routine.
Figure 2
Figure 2
CP and CCP during the process of decontamination.
Figure 3
Figure 3
Course of the number of inspections by the IHU comparing the three years of the survey.
Figure 4
Figure 4
Development of the compliance of results according to the limiting values of the TrinkwV in the three risk areas (surveillance of IHEM).
Figure 5
Figure 5
Measures executed for preventive and reasons of decontamination over the period from 2004 till 2006 (surveillance of IHEM). A = Immediate re-inspection; B = Re-inspection within 7 days; C = Re-inspection within 14 days; D = Re-inspection without POU filter; E = Re-inspection/processing of aerators; F = Flushing; G = ClO2-decontamination; H = Installation of POU filter; I = POU reversal; K = POU remains; L = Heating up; M = Closure of tap
Figure 6
Figure 6
Results of examinations for heterotrophic plate counts/ml in the three risk areas (DHC 2005).
Figure 7
Figure 7
Results of examinations for Coli-like resp. E. coli in the three risk areas (DHC 2005).
Figure 8
Figure 8
Results of examinations for Pseudomonas spp. in the three risk areas (DHC 2005).
Figure 9
Figure 9
Results of examinations for Legionella spp. in the three risk areas (DHC 2005).
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References

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