Case study: Sherwood Forest NHS minimises the risk of Pseudomonas

Engineering risk assessment minimises the risk of Pseudomonas aeruginosa contamination and saves lives

Regular checks must be made to water supplies in hospitals in order to detect potentially-harmful organisms such as Pseudomonas and Legionella

The organisation

King’s Mill Hospital is part of the Sherwood Forest NHS Foundation Trust, which provides hospital services for 420,000 people across Mansfield, Ashfield, Newark, Sherwood and parts of Derbyshire and Lincolnshire.

The trust has three hospitals, King’s Mill, Newark and Mansfield Community Hospitals, as well as running some services from Ashfield Community Health Village.

In 2016-2017 the trust helped deliver 3,400 babies and saw 150,000 patients at the King’s Mill Emergency Department.

The challenge

In 2012 an outbreak of Pseudomonas aeruginosa in Belfast resulted in the deaths of three newborn babies and infections have since become a real concern for hospitals and health centres across the country.

The dutiful completion of water sampling for Pseudomonas aeruginosa within the augmented care facilities at King’s Mill Hospital - every 6 months, in line with HTM04-01 Part C - started to return an increased number of positive water sample counts at various locations.

The sample results were reviewed by the Water Safety Group [WSG] and it was agreed that a more-detailed understanding of the potential causes was needed.

The WSG commissioned an engineering assessment of the augmented care areas to help with the root cause analysis.

During the previous 12 months - essentially two rounds of sampling - the number of positive water samples were increasing.

It is inevitable that there will be some positive counts with each round of sampling and action taken to resolve those sporadic counts. However, repeat counts at outlets for each period of sampling ‘flagged’ up more of a concern to the WSG.

And the consultant microbiologist was keen to explore all potential causes for the counts. For example, was there a failure in local use and management of the outlet that the sampling programme was detecting?

The solution

The clinical risk assessment completed by the infection prevention control team had already identified the six areas within the hospital classed as augmented care.

The trust then worked with experts from The Water Hygiene Centre to carry out the more-indepth assessments.

The engineering assessment focused on all outlets in these six areas and 298 outlets were looked at in total.

The onsite assessment took eight days, the risk assessment being supported by the estates competent persons who were able to facilitate access to the areas, as well as behind the scenes i.e. IPS panels.

For each outlet there were 36 criteria assessed, such as who uses the outlet, the type of fittings, dimensions of the outlet, details of associated components, the hot and cold water supply temperatures, frequency of use, and relative proximity of soap, sanitiser and towel dispensers.

The results

The engineering risk assessment was reported in an Excel spreadsheet, with a separate worksheet being dedicated to one of the six augmented care areas.

Having the report format in Excel had two benefits; the ability to filter data quickly and the conditional formatting allowed for quick identification of non-compliant occurrences through cell colouring.

This format allowed the WSG to quickly assimilate the number of issues at each outlet, occurrences such as use of flexi hoses, poor position of return loops, failing return loop temperatures, and excess use of components associated with the outlets.

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