138 NHS Trusts report over 4,500 cases of Pseudomonas aeruginosa infections between March 2022 & March 2023.

Pseudomonas aeruginosa¹ (P. aeruginosa) can be defined as:

P. aeruginosa is a Gram-negative bacterium readily found in a wide range of sources including soil and water.  P. aeruginosa is an opportunistic, ubiquitous organism which can cause a wide range of infections whether a person is healthy or immunocompromised.

This organism can affect the Central Nervous System, cause bacteremia, endocarditis, urinary tract infections, issues with the respiratory system, contamination of surgical wounds and burns as well as eye & ear infections.

Pseudomonas aeruginosa is a Gram-negative bacterium often found in soil and ground water. P. aeruginosa is an opportunistic pathogen and it rarely affects healthy individuals. It can cause a wide range of infections, particularly in those with a weakened immune system, for example cancer patients, newborns and people with severe burns, diabetes mellitus or cystic fibrosis.

P. aeruginosa infections are sometimes associated with contact with contaminated water. In hospitals, the organism can contaminate devices that are left inside the body, such as respiratory equipment and catheters. P. aeruginosa is resistant to many commonly-used antibiotics.

By compiling recent reports from NHS England and the Department of Health² , we begin to build an interesting picture, relating to P. aeruginosa and where cases can originate.

138 NHS Trusts in England have submitted data on reported cases of P. aeruginosa, every year since 2017. Our report below focuses on the March - March reports from the years 2019 - 2023.

But what does this data really show us?

We can see that throughout 2019 and in early 2020, reported cases of P. aeruginosa that originated in UK Hospitals never exceeded 300 total cases per month across all reporting parties in the UK. However, at the start of 2021, this number rose to highs of over 400 total cases per month, with a peak in 2022 of around 350 cases per month.

Much higher numbers of cases were reported with respect to Community onset. Again, in a similar trend, following March 2020 we see an increased number of reported cases and quite a steep rise at that. Highs of around 530 cases per month in mid 2020, which again were replicated in mid 2021 and 2022.

P. aeruginosa cases in the UK reported by Department of Health. Community and Hospital Onset only. 2019 - 2023

When taken in its entirety, the data set available from NHS England shows that on average there are around 360 reported cases³ of P. aeruginosa every month in the UK.

Whilst we can see that the number of cases originating in Hospitals track at less than half of those attributed to Community Onset, it would be potentially dangerous for NHS Estates and Facilities teams to become complacent, given that the trend line of Total Cases Per Month is showing a steady incline as reports are prepared for the second quarter of 2023.

P. aeruginosa cases in the UK reported by Department of Health. Hospital Onset only. 2019 - 2023

How Can NHS Estates and Facilities Teams Help Flatten The Curve?

According to HTM 04-01 Safe water in healthcare premises, Part C -Pseudomonas aeruginosa – advice for augmented care units, a guidance document provided by Department of Health and NHS England, "several outbreaks of P. aeruginosa have been attributed to contaminated water systems in hospitals."

Hot and cold water services within healthcare premises are identified as one area of NHS Estates that can be monitored, controlled and maintained in a way which could reduce transmission rates of P. aeruginosa.

HTM 04-01 Part C identifies a number of design and installation challenges that should be addressed to reduce the risk of patients contracting P. aeruginosa. These include:

• Poor hygiene
• Infrequently used water outlets and low water throughput
• Oversized water storage tanks, flexible hoses, stagnant water, poor temperature control, long branch pipes and dead-legs
• Incorrect siting and installation of showers and wash-hand basins (in new premises)
• Evolutions in tap design - T shaped Thermostatic Mixing Valve VS Integral TMVs VS Remote Sensor Taps
• The choice and type of water outlets for the augmented care setting based on a risk assessment of infection-control and scalding issues.
• Certain designs of flow straightener may present a greater surface area for colonisation and support the growth of organisms
• Sensors should be offset or positioned such as to reduce the risk of accidental contamination of the outlet and be positioned so that point-of-use (POU) filters can be used
• Taps, components and fittings should be removable and easily dismantled for cleaning and disinfection

Further detail can be found here - https://www.england.nhs.uk/publication/safe-water-in-healthcare-premises-htm-04-01/

A Global Issue

Further research has shown that P. aeruginosa is clearly not only an issue in England’s NHS Trusts, but that this bacterium causes issues all over the world.  

Northern Ireland:

In 2011/ 2012 in Northern Ireland four (4) babies tragically died from an infection from this organism in the neonatal units in two separate hospitals. It was determined that the source of the infections were contaminated taps. 

Scotland:

infections are sometimes associated with contact with contaminated water. In hospitals P. aeruginosa can be transmitted via contaminated water, invasive equipment such as ventilators & catheters and poor hygiene. Information from Health Facilities Scotland indicated that 25% of Healthcare Associated Infections was due to pathogens in the water supply - the rest was from poor hygiene practices.

United States of America:

In March 2023 the US Centers for Disease Control & Prevention (CDC) recommended that a brand of eye drops was withdrawn due to the number of cases involving P. aeruginosa which resulted in damage, blindness & in one situation removal of an eye.

A New Priority

Some strains of  P. aeruginosa (CRPA) are now resistant to antibiotics and has been classified by The World Health Organisation (WHO) as a Priority 1 (highest rating) organism to find a new antibiotic.

How Can We Help?

Check out our Legionella (Water Hygiene) Control and Management training brochure to see all of our courses

HTM 04-01 Part C goes on to state that, in relation to patient safety in Augmented Care Units:

Management should ensure that all staff with responsibility for cleaning should be adequately trained and made aware of the importance of high standards of cleanliness (see also paragraphs 1.21–1.29 in HTM 0401 Part A and paragraphs 6.29–6.30 in HTM 04-01 Part B). Refresher training should be given where a specific area does not maintain the expected standard of cleanliness.

In response to this, we have a training course designed specifically for identifying the risks of P. aeruginosa and other waterborne pathogens in water systems, which has been well received by attendees in the recent past:

Course was interesting and the tutor, Les, was very knowledgeable and happy to discuss points as well as delivering the course so, it was not a sit there and listen style course. I Would definitely recommend and use PPL for training in the future.

Sean - Healthy Buildings International

To learn more about our online training course - Introduction to The Risk of Pseudomonas aeruginosa and Other Waterborne Pathogens - you can check out the course page, where you will find a full course overview, key learning areas and available training dates.

Alternatively, you can contact one of our friendly and knowledgeable Account Managers on 0333 121 1215 or by emailing info@ppltraining.co.uk

Footnotes

1. Pseudomonas is a type of bacteria (germ) that is found commonly in the environment, like in soil and in water. Of the many different types of Pseudomonas, the one that most often causes infections in humans is called Pseudomonas aeruginosa, which can cause infections in the blood, lungs (pneumonia), or other parts of the body after surgery.
2. Based on data compiled by NHS Acute Trusts, Integrated Care Boards and UK Health Security Agency Centres (which replaced Public Health England Centres in 2021)
3. A mean value of 360 reported cases per month does not take into account those cases that provide no information for onset, or are categorised as 'Other'.