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HOSPITAL
                                                                            Water quality regulations /                    SOLUTIONS


            WATER QUALITY: VARIOUS EUROPEAN MONITORING POLICIES


            France, Germany, the United Kingdom and the majority of   The Department of Health and Social Care (DHSC), Ministry
            European countries, each has their own specific regulatory   of Health for the United Kingdom, has addressed
            requirements for monitoring bacteria in water systems.        the issue of tap and water system contamination
                                                        4.1 million         by these bacteria.
            These regulations have a common premise
            (circulating loops, hot water temperatures, etc.) but   healthcare acquired   The Health Technical Memorandum (HTM 04-01)
            they also have specific aspects that could provide   infections in Europe    updated in 2017, provides guidance on best
            inspiration for other countries.                of which          practice for monitoring and testing for these
            In the majority of European countries there is                    two pathogens, and identifying the level of
            a legal obligation to safeguard the bacteriological   37,000      contamination in water, to ensure compliance
            quality of the water in the system by regular                    with current regulations.
            monitoring, sampling and analysis. However,    are fatal
            the methods, and subsequent follow-up action, differ.          For Pseudomonas aeruginosa, action is initiated
                                                                         as soon as the alert level is reached, that is to say,
            In France, the search for Legionella is obligatory. The Directive   above 1 CFU/100mL, as is done in France.
            of 1  February 2010 identifies three levels of monitoring and
               st
            sampling protocols. Since 1  January 2012, monitoring has been   In Germany, in the framework of monitoring for Pseudomonas
                                st
            extended to all buildings open to the public.         aeruginosa, hospitals and healthcare establishments must test
            Germany has adopted the same threshold levels as France,   twice a year. The satisfactory level is 0 CFU/100mL.
            while the United Kingdom is stricter: it conducts additional
            testing at levels over 100 Colony Forming Units per litre   36%   Remember that this bacteria, which colonises the
            (CFU/L) and initiates curative procedures above    of cases  system from the interior of tap/mixer spouts, rapidly
            1,000 CFU/L.                                                 becomes entrenched. If no solution is put in place once
                                                          of Pseudomonas
                                                             originate   Pseudomonas aeruginosa is established in a mixer or tap,
            Pseudomonas aeruginosa, considered the third                 it will progressively colonise the tails and pipework.
            largest cause of fatal nosocomial infections, is also   in hospitals  At this stage it will be impossible to eradicate and will
            being monitored. In France there aren’t any regulations.   become a threat to the whole system.
            Nevertheless, the technical guide “Water in healthcare
            establishments” drawn up in 2005 by a working group under
            the aegis of the Ministry of Health, mentions the monitoring levels
            for Bacillus pyocyaneus (Pseudomonas).
            This guide recommends quarterly checks at points where water is
            considered to be representative of the actual quality of distributed
            water.





                    The bacteria that form biofilms on the surface of  certain  The European Centre for Disease Prevention and Control
                    materials are responsible for  one third of  healthcare-  (ECDC) calculates that HCAIs affect 4.1 million patients every
                    acquired infections (HCAIs).                  year and are responsible for 37,000 deaths annually.
                    According to the National Institute for Health and Care  Not forgetting that non-healthcare buildings that are open
                    Excellence  (NICE, 2014), it is estimated that 300,000  to the public are also at high risk. In effect, according to
                    patients in England acquire an HCAI as a result of care within   statistics by the French National Institute for Public Health
                    the NHS. In 2018/19, the prevalence of HCAIs in hospitals   Surveillance  (InVs), 30% of  Legionella  cases identified in
                    in England was 7.5%. In a 2012 study by the French national   2015 were linked to visits to hotels, tourist accommodation,
                    Institution for Health Monitoring  (IHM), one in twenty  (5%)  campsites, swimming pools and sports stadia, compared
                    French healthcare patients contracted an infection from the   to 14% linked to healthcare facilities (hospitals, retirement
                    facility that was caring for them. This represents approximately   homes, etc.).
                    750,000 infections a year, of which 4,200 were fatal.























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