Water haz­ard

Ex­ec­u­tives must work col­lab­o­ra­tively to pre­vent sys­tem con­tam­i­na­tion

Modern Healthcare - - OPINIONS COMMENTARY - Matthew Greis is sys­tems di­rec­tor for plant en­gi­neer­ing, op­er­a­tions and main­te­nance at St. El­iz­a­beth Health­care in Edge­wood, Ky.

Hear that? It’s the sound of water gen­tly cas­cad­ing from a dec­o­ra­tive foun­tain in a hospi­tal lobby. But, if the mur­mur of flow­ing water is meant to in­still a sense of calm among pa­tients, vis­i­tors and staff, the re­al­ity is far more dis­qui­et­ing. And news­wor­thy. Re­cently, a num­ber of news or­ga­ni­za­tions pub­lished sto­ries on a study in the Fe­bru­ary is­sue of In­fec­tion Con­trol and Hospi­tal Epi­demi­ol­ogy (read the study at bit.ly/ that

zblzoz) un­der­scored the dan­ger of these pop­u­lar ar­chi­tec­tural fea­tures: In this case, a dec­o­ra­tive water wall in a Wis­con­sin-based hospi­tal lobby was linked to an out­break of Le­gion­naires’ dis­ease.

And it’s not only water in foun­tains we need to worry about. In the fight against hos­pi­ta­lac­quired in­fec­tions, fa­cil­i­ties are turn­ing their at­ten­tion to their en­tire water sup­ply, an of­ten over­looked and con­trol­lable source of noso­co­mial in­fec­tions. Wa­ter­borne pathogens, such as Le­gionella, Pseu­domonas, M. avium and other harm­ful bac­te­ria, can in­fil­trate and flour­ish within a fa­cil­ity’s plumb­ing sys­tem, some­times de­spite dili­gent in­fec­tion-con­trol ef­forts. The Cen­ters for Dis­ease Con­trol and Preven­tion re­ported that the in­ci­dence of Le­gion­naires’ dis­ease has nearly tripled over the past decade and has es­ti­mated that the in­fec­tion re­sults in up to 18,000 hos­pi­tal­iza­tions each year, more than 10% of which are fa­tal, and that wa­ter­borne ill­nesses cost the health­care sys­tem as much as $539 mil­lion an­nu­ally.

No won­der then that the Amer­i­can So­ci­ety for Heat­ing, Re­frig­er­at­ing and Air Con­di­tion­ing Engineers has pro­posed a new stan­dard prac­tice, No. 188, with re­quire­ments for preven­tion of Le­gionel­losis in build­ing water sys­tems. This ini­tia­tive comes at a time when there is a broad-based and re­newed fo­cus on elim­i­nat­ing all HAIS.

What this boils down to for health­care fa­cil­i­ties is a height­ened aware­ness of just how crit­i­cal it is to pro­vide a clean, safe en­vi­ron­ment in which pa­tients can heal. From a fa­cil­i­ties per­spec­tive, it means mak­ing in­fec­tion con­trol a pri­or­ity and em­ploy­ing a team that will do what it takes to achieve it. For many, that means start­ing with pathogen-free water.

St. El­iz­a­beth Health­care, a mul­ti­fa­cil­ity trol—work­ing hand-in-hand. Too of­ten, these op­er­ate at cross-pur­poses, with the in­fec­tion-con­trol team seen as spenders while en­gi­neer­ing tries to keep costs down. St. El­iz­a­beth avoided this im­passe by build­ing the cost of in­fec­tion con­trol into its fa­cil­i­ties and main­te­nance bud­gets. Hospi­tal ad­min­is­tra­tors who are installing a dis­in­fec­tion sys­tem ought to make this a di­rec­tive, in­sist­ing on a col­lab­o­ra­tive ap­proach that be­comes part of the or­ga­ni­za­tional cul­ture.

Fi­nally, St. El­iz­a­beth formed a com­mit­tee in 1997 that meets reg­u­larly to dis­cuss the on­go­ing preven­tion of wa­ter­borne ill­nesses. It in­cludes rep­re­sen­ta­tives from in­fec­tion con­trol, plant en­gi­neer­ing and main­te­nance, nurs­ing ad­min­is­tra­tion, risk man­age­ment, en­vi­ron­men­tal ser­vices and house­keep­ing, and se­nior ser­vices. It may not have the glitz and glam­our of more vis­i­ble build­ing ini­tia­tives, but if bud­get cuts are re­quired, we will never com­pro­mise pa­tient safety. The risks are too great, es­pe­cially as a sin­gle Le­gionella in­fec­tion costs an av­er­age of $86,000 to treat. Cou­pled with the cost of treat­ing Pseu­domonas-re­lated pneu­mo­nias and other in­fec­tions—plus the pos­si­bil­ity of lit­i­ga­tion, re­me­di­a­tion and loss of busi­ness and rep­u­ta­tion—it’s clear that a pre­ven­tive pro­gram more than pays for it­self.

How much of a pri­or­ity is this? About two years ago, St. El­iz­a­beth ac­quired an am­bu­la­tory surgery cen­ter and in the cen­ter of the lobby was a beau­ti­ful foun­tain. The first thing we did was turn off the water and con­vert it into a planter. As nice as foun­tains are to see and hear, it is far more im­por­tant to abide by one of the fun­da­men­tal prin­ci­ples of medicine: First, do no harm.

Ad­min­is­tra­tors should in­sist on a col­lab­o­ra­tive ap­proach to in­fec­tion con­trol.

health­care provider in north­ern Ken­tucky and greater Cincin­nati, has long taken a proac­tive stance on in­fec­tion con­trol. Its Le­gionella dis­ease preven­tion plan, launched in 1997 when the is­sue be­came a lo­cal con­cern, en­abled it to mit­i­gate Le­gionella and other wa­ter­borne pathogens within its fa­cil­i­ties. The steps taken—lo­gis­ti­cally and ad­min­is­tra­tively— were straight­for­ward and can be eas­ily im­ple­mented by most hos­pi­tals.

Of four water dis­in­fec­tion sys­tems in­ves­ti­gated by hospi­tal staff, St. El­iz­a­beth chose cop­per sil­ver ioniza­tion. In ad­di­tion to be­ing en­vi­ron­men­tally safe, it was also long-term and cost-ef­fec­tive as it con­tin­u­ously treats biofilm in the do­mes­tic water with­out the need to shut down the sys­tem. The chlorination op­tion re­quired that the sys­tem be shut down for hours to al­low the chlo­rine to work. Sim­i­larly, the ther­mal erad­i­ca­tion op­tion re­quired su­per­heat­ing the water, which meant shut­ting the sys­tem to let it cool or risk burn­ing pa­tients. Ul­tra­vi­o­let ir­ra­di­a­tion was not a sys­temic so­lu­tion and was in­ca­pable of erad­i­cat­ing bac­te­ria through­out the en­tire fa­cil­ity.

St. El­iz­a­beth also im­ple­mented ran­dom sam­pling and test­ing as well as pre­ven­tive main­te­nance, which in­cluded check­ing any ar­eas where water might re­main stag­nant. The sys­tem is easy to main­tain, and we know it is work­ing be­cause sam­pling con­tin­ues to pro­duce neg­a­tive re­sults.

The most crit­i­cal step was to in­sist on a team ap­proach, with the two key de­part­ments—plant en­gi­neer­ing and in­fec­tion con-

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