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.
Executives must work collaboratively to prevent system contamination
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/zbLzoz) that 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 hospital-acquired 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 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 control—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.
Matthew Greis is systems director for plant engineering, operations and maintenance at St. Elizabeth Healthcare in Edgewood, Ky.
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