University College London, Division of Infection and Immunity, London, UK.
University College London Hospitals, Clinical Microbiology, UCLH Environmental Research Laboratory, London, UK.
J Med Microbiol. 2023 May;72(5). doi: 10.1099/jmm.0.001698.
in healthcare shower waters presents a high risk of infection to immune-suppressed patients; identifying the colonization-status of water outlets is essential in preventing acquisition. Testing frequencies may be insufficient to capture presence/absence of contamination in healthcare waters between sampling and remediation activities. Standardization of outlets may facilitate the management and control of . This study aims to monitor shower waters and drains for in augmented and non-augmented healthcare settings every 2 weeks for a period of 7 months during remedial actions. All shower facilities were standardized to include antimicrobial silver-impregnated showerhead/hose units, hose-length fixed to 0.8 m and replaced every 3 months. Standard hospital manual decontamination/disinfection occurred daily. Thermostatic-mixer-valves (TMVs) were replaced and disinfected if standard remediation unsuccessful. Of 560 shower and drain samples collected over 14 time-points covering 7 months, colonized 40 %(4/10; non-augmented) and 80 %(8/10; augmented-care) showers in the first week. For each week elapsed, new outlets became contaminated with by 18-19 % (<0.001) in shower waters (OR=1.19; CI=1.09-1.31) and drains (OR=1.18; CI=1.09-1.30). occurrence in shower water was associated with subsequent colonization of the corresponding drain and vice versa (chi-square; <0.001) with simultaneous contamination present in 31 %(87/280) of areas. TMV replacement was ineffective in eradicating colonisation in ~83 % of a subset (6/20; three per ward) of contaminated showers. We demonstrate the difficulties in eradicating from hospital plumbing, particularly when contamination is no longer sporadic. Non-augmented care settings are reservoirs of and should not be overlooked in outbreak investigations. Antimicrobial-impregnated materials may be ineffective once colonization with is established beyond the hose and head. Reducing hose-length insufficient to prevent cross-contamination from shower drains. colonization can be transient in both drain and shower hose/head. Frequent microbiological monitoring suggests testing frequencies following HTM04-01 guidelines are insufficient to capture the colonization-status of healthcare waters between samples. Disinfection/decontamination is recommended to minimize bioburden and the effect of remediation should be verified with microbiological monitoring. Where standard remediation did not remove contamination, intensive monitoring supported justifying replacement of showers and contiguous plumbing.
在医疗保健领域，淋浴水对免疫抑制患者存在高度感染风险；因此，确定出水口的定植状态对于预防感染至关重要。在采样和修复活动之间，测试频率可能不足以捕捉医疗用水中污染的存在/缺失。出水口的标准化可能有助于管理和控制。本研究旨在在修复期间，每隔两周对增强和非增强医疗保健环境中的淋浴水和排水进行为期 7 个月的监测。所有淋浴设施都标准化，包括抗菌银浸渍淋浴喷头/软管组件，软管长度固定在 0.8m，并每 3 个月更换一次。每天进行标准医院消毒/消毒。如果标准修复不成功，则更换和消毒恒温混合阀（TMV）。在 7 个月期间的 14 个时间点共采集了 560 个淋浴和排水样本，在第一周，40%（非增强组 4/10；增强组 8/10）的淋浴和排水受到定植。每过去一周，新的出水口就会被污染，淋浴水中的定植率会增加 18-19%（<0.001）（OR=1.19；CI=1.09-1.31），排水中的定植率也会增加（OR=1.18；CI=1.09-1.30）。淋浴水中的定植与相应排水的定植之间存在关联，反之亦然（卡方检验；<0.001），同时有 31%（87/280）的区域存在同时污染。在大约 83%（20 个中的 6 个；每个病房 3 个）被污染的淋浴器中，TMV 的更换并不能有效消除定植。当医院管道中的污染不再是零星存在时，从医院管道中根除定植变得非常困难。非增强护理环境是定植的蓄水池，在暴发调查中不应被忽视。一旦定植菌超出软管和喷头，抗菌浸渍材料可能就无法有效。减少软管长度不足以防止淋浴排水的交叉污染。定植可以在排水和淋浴软管/喷头中短暂存在。频繁的微生物监测表明，根据 HTM04-01 指南进行的测试频率不足以在采样之间捕捉到医疗用水的定植状态。建议进行消毒/去污，以最大程度减少生物负荷，并通过微生物监测验证修复效果。如果标准修复未能消除定植污染，强化监测支持更换淋浴器和相邻管道的正当性。
