News - July 2017
Sensing the need for change
In 2012 four babies died from Pseudomonas infection at the Royal Jubilee Maternity and Altnagelvin hospitals in Northern Ireland.
A probe into their deaths revealed the outbreaks were linked to contaminated tap water in the intensive care rooms of the neonatal units.
Following the investigation, The Department of Health published new technical guidance on preventing Pseudomonas in water systems, a document which was updated in 2013.
It states that, as water system and tap design has become more complex, in some cases this has created the ideal breeding ground for potentially-deadly bacteria like Pseudomonas to thrive.
And it specifically alluded to potential problems with taps in hospital wards and washrooms.
Over the years tap design has evolved. In older installations, thermostatic control of water temperature was achieved by a separate thermostatic mixing valve (TMV), typically located behind the sanitary assembly panel to which a handwash basin or other assembly was fitted, which then supplied water to the hot connection of a manual mixing tap or separate tap.
Many new installations now include more-modern taps with integral TMVs. They are usually manually controlled and can be adjusted to further reduce outlet temperature to fully cold.
And, for some applications, remote sensor-operated taps are also available.
But the technical guidance states: “In some instances these developments have led to a more-complicated internal tap design which may increase the need for additional routine maintenance, including decontamination, to mitigate the risk of contamination by Pseudomonas.”
It advises that choice of tap should be based on a risk assessment of both infection control and scalding issues.
“There is some evidence that the more complex the design of the outlet assembly, for example some sensor-operated taps, the more prone to Pseudomonas colonisation the outlet may be,” it adds.
At the time of the report, sensor taps were becoming increasingly popular in healthcare settings as they negated the need for people to touch the tap itself and, therefore, helped prevent the spread of infection.
Speaking to hdm, Paul Musgrove, UK development manager at Conti, explains: “This issue creates great debate between engineers, infection control teams, and manufacturers, with so many confused thoughts regarding sensor technology.
“In truth, sensor products with hands-free washing should be the ideal solution for all clinical taps in and around wards, departments and theatres.
“Additionally, they should also be used in public and patient toilets.”
But he said that the design of modern healthcare environments, and refurbishments, should be better planned to ensure they support the products that will be installed within them.
“In my opinion, the poor press and reputation sensor taps receive is down to the selection of products, where the contractor just installs and walks away because the product functions,” he added.
“In reality, we should be asking has the environment for the sensor been designed correctly?
“Reflectancies, mirrors, windows, wall finishes, and even skin tone can all have an effect on a product’s efficiency
“The majority of sensor products sold within the UK are also not the always the best quality, and many brands come from factories where quality control is not always the best and product selection is made on price, rather than the correct specification, which in a health environment is rather disappointing.”
He also questioned how many products currently installed in hospitals have WRAS certification, which demonstrates full compliance with the requirements of current water supply regulations.
“You would hope all,” he said. “However, WRAS focus among clients has really only come to the forefront over last five years or so.”
One of the key focus points, he added, is water retention within the tap solenoid, which is past the mixing point and could possibly harbour biofilm over a period of time, which can then lead to infection outbreaks.
“Some solenoids I have seen over the years can get very hot due to the power being supplied to them, and again the use of cheaper component parts which could be improved upon,” said Musgrove.
“But these infection issues can be resolved very quickly with regular flushing through hygiene settings.
“Additionally, it is possible to carry out thermal disinfections, which should be completed as part of planned maintenance by experienced and trained members of the estates teams.
“Yes, taps got a bad press after the Irish outbreak. However, the other angle to focus an opinion on is in regards to estate maintenance regimes.
“With staff cutbacks, financial cutbacks, and the outsourcing of routine maintenance; can an estates manager be 100% confident that his supply and pipework are in fantastic shape, and therefore, the water is of the desired quality and delivered at the correct temperatures?”
Conti is currently awaiting WRAS approval on its new Ultra range, which it is hoping will change attitudes over the continued use of sensor technology.
Musgrove said: “With a smooth internal body, and being anti-bacterial, it has been designed to address all the key arguments, and provides engineered solutions that work.”