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Hi Cate,
As Michael said in his email, the En Health guidelines apply to the ICU water supply, and you would have to have a water quality management plan in place. In my experience, I would consider it to be very wise to implement water testing while the unit is being commissioned. This gives time to rectify any problems before patients enter the area, which is much more straightforward, and safer than after patients are using the area. The relatively small cost of testing compared to the cost of an infection or the upheaval from trying to fix or investigate plumbing while providing bottled water and working around patients makes this very much worthwhile. There may also be issues that need to be fixed by builders before practical completion can take place for the area. It is always important to know what levels of water quality you are aiming for (ADWG standards or higher) when testing, and also to test the incoming supply at the point closest to where it enters the hospital to ensure that if any problems are found they can be properly traced.
You would definitely need to do more sensitive testing than cooling tower testing for a water supply into a hospital. Specific drinking water microbiological tests are much more sensitive and detect a lower number of organisms in the water (detection limit of <1000cfu/ml for cooling tower testing and <1 cfu/ml for drinking water testing with the laboratories we use). They also test at two temperatures, a lower temperature test for 'environmental' organisms, and a higher temperature for potentially human pathogenic organisms when they test the HCC (although 'environmental' organisms can be an issue in very immunocompromised patients).
Cooling tower testing also tests only for Legionella species and for Heterotrophic Colony Count (HCC, sometimes called HPC (Heterotrophic Plate Count) or TPC(Total Plate Count) as well). With a hospital supply, especially into an ICU, other organisms may need to be tested for example (but not limited to) Pseudomonas aeruginosa and amoebae.
Two other very helpful resources when developing a plan of testing are the :
Queensland Guidelines for managing microbial water quality in healthcare facilities 2013
and a new resource, which is American, form the CDC but has good information on how to prepare risk management plans for water systems:
http://www.cdc.gov/legionella/downloads/toolkit.pdf
The Australian Drinking Water Guidelines are also a help if you want to test any other parameters outside of microbial testing, such as lead, iron, copper etc., that may be relevant to your patients.
https://www.nhmrc.gov.au/guidelines-publications/eh52
Regards,
Sarah Bailey MSc PGDip Med Myc
Senior Consultant
QED Environmental Services
http://www.qed.net.au
0415 879028
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P Please consider the environment before printing this email
Hi Cate
I will defer to experts such as Glenys Harrington on this topic, but would just point out that water quality needs to consider more than ‘cooling tower’ testing, which is really only looking for large numbers of organisms (biofilm) or any number of Legionella. And we need to consider the different risks for difference water used for hand washing and water provided to immunocompromised patients to drink. Therefore any testing needs to reflect this.
As per the current enHealth guidelines on water quality, your overall water quality management plan should reflect these risks. (see http://www.sahealth.sa.gov.au/wps/wcm/connect/9584a2804b1cdf74b707ff0b65544981/enHealth+Guideline+Final.pdf?MODAJPERES&CACHEID9584a2804b1cdf74b707ff0b65544981 ) And so any testing should reflect this as well.
Cheers
MichaelMichael Wishart
Infection Control CoordinatorA 627 Rode Road, Chermside QLD 4032
P (07) 3326 3068 | F (07) 3607 2226 | E michael.wishart@svha.org.au | W http://www.hsnph.org.au
[cid:image001.png@01D01926.61F1C2B0]P Please consider the environment before printing this email
Hi everyone,
Can I get your advice on need for water testing in our new ICU before it is commissioned for use. Is water testing required, if so from which source/s? Should they be managed in the same manner as routine cooling tower testing?
thanksCate Coffey | Clinical Nurse Consultant
Infection Prevention and Control Unit | Central Australia Health Service
Northern Territory Government
Alice Springs Hopsital, Gap Rd, Alice Springs
GPO Box 2234, Suburb, NT Postcode
p … 08 89517737
e … cate.coffey@nt.gov.au http://www.nt.gov.au/healthOur Vision: Better health outcomes for all Central Australians
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