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HOSPITAL
Infection control / SOLUTIONS

PSEUDOMONAS AERUGINOSA MONITORING FOR PSEUDOMONAS
AERUGINOSA

Almost 40% of all cases of Pseudomonas aeruginosa The Department of Health and Social Care (DHSC)
originate while the patient is in hospital care (39%). conducted a study into contamination by Pseudomonas
Pseudomonas aeruginosa, requires 2 elements aeruginosa in mixers/taps and the water supply system.
in order to develop: 4.1 million This study resulted in the publication of technical
- water at a temperature between 4°C and 42°C healthcare acquired guidance written specifically for augmented care
(optimal development between 30°C and 37°C). units. This latter was incorporated in the revised
- the ability to oxidise. infections in Europe version of the HTM 04-01 Part B in 2016 which
of which outlines what action to take when healthcare
Pseudomonas aeruginosa is transmitted by 37,000 facilities become contaminated with Pseudomonas
hand by healthcare staff and via infected medical aeruginosa.
equipment. Invasive surgery presents a high risk are fatal In order to assess the level of water contamination
of transmission of this type of infectious agent. by Pseudomonas aeruginosa, the DHSC recommends
sampling the first water to be delivered from the outlet.
There are several levels of Pseudomonas aeruginosa Furthermore, to maximise the recovery of free-floating
contamination. bacteria it recommends taking samples:
- at least 2 hours (preferably longer) after the last draw-off
Pseudomonas aeruginosa development at outlets used on a daily basis.
in the spout - on outlets that are used infrequently.
Pseudomonas aeruginosa primarily contaminates mixer and tap
spouts, since it needs a mixture of air and water to develop. The Department of Health and Social Care (DHSC), Ministry
Biofilm, niches and cavities in the spout walls protect of Health for the United Kingdom, has addressed
the bacteria from treatments, and provide the ideal the issue of tap and water system contamination
environment for the bacteria to proliferate. by these bacteria.
At the outlet, Pseudomonas aeruginosa finds all Almost 40% The Health Technical Memorandum (HTM 04-01)
the necessary conditions to develop and proliferate, updated in 2017, provides guidance on best
establishing permanent colonies in mixers and taps. of Pseudomonas practice for monitoring and testing for these
Even cleaning spouts and flow straighteners aeruginosa cases originate two pathogens, and identifying the level of
regularly is ineffective. while the patient is in hospital contamination in water, to ensure compliance
care with current regulations.
Pseudomonas aeruginosa development For Pseudomonas aeruginosa, action is initiated
Source: Public Health England 2021
in flexible hoses and pipework Pseudomonas aeruginosa as soon as the alert level is reached, that is to say,
bacteraemia annual
Once established in the biofilm in mixers and taps, figures above 1 CFU/100mL, as is done in France.
Pseudomonas aeruginosa continues to develop In Germany, in the framework of monitoring for
and will gradually colonise the flexibles and pipework unless Pseudomonas aeruginosa, hospitals and healthcare
an effective solution is put in place. establishments must test twice a year. The satisfactory level is
0 CFU/100mL.
By this stage it is impossible to eradicate Pseudomonas
aeruginosa, which then becomes a threat to the entire water
system. Monitoring levels for Pseudomonas aeruginosa:
Satisfactory level < 1 CFU/100mL
Unacceptable level > 10 CFU/100mL
CFU/mL: Colony Forming Units/millilitre
In its report the DHSC clearly indicates that disinfecting the water
supply (hot and cold) is insufficient for removing an established
biofilm. It recommends that, where installed, removable taps
should be periodically removed for internal cleaning to remove
any biofilm and bacteria residing within.
Healthcare facilities should establish regular cleaning protocols.
See more about DELABIE’s solutions on page 8.

The bacteria that form biofilms on the surface of certain 750,000 infections/year, of which 4,200 were fatal.
materials are responsible for one third of healthcare- The European Centre for Disease Prevention and Control
acquired infections (HCAIs). (ECDC) calculates that HCAIs affect 4.1 million patients every
According to the National Institute for Health and Care year and are responsible for 37,000 deaths annually.
Excellence (NICE, 2014), it is estimated that 300,000 Not forgetting that non-healthcare buildings that are open to
patients in England acquire an HCAI as a result of care within the public are also at high risk. In effect, according to statistics
the NHS. In 2018/19, the prevalence of HCAIs in hospitals in by the French IHM, 47% of Legionella cases identified in
England was 7.5%. 2019 were linked to visits to hotels, tourist accommodation,
A 2012 study, repeated in 2017, by the French national campsites, swimming pools and sports stadia, compared
Institution for Health Monitoring (IHM), found that one in to 11% linked to healthcare facilities (hospitals, retirement
twenty (5%) French healthcare patients contracted an homes, etc.).
healthcare acquired infection. This represents approx.

Hospital solutions 5