To describe engineering and holistic interventions on the contamination of water outlets with Pseudomonas aeruginosa and the resulting rates of infections in a large Intensive Care Unit (ICU).

The Queen Elizabeth Hospital Birmingham (QEHB) part of University Hospitals Birmingham (UHB) NHS Foundation Trust is a tertiary referral teaching hospital in Birmingham, UK and provides clinical services to nearly 1 million patients every year. Water sampling undertaken on the ICU indicates 30% of the outlets were positive for P. aeruginosa at any one time. Molecular typing via whole genome sequencing of patient and water isolates suggested there was  >30% transmission rate of P. aeruginosa from the water to patients on the ICU. QEHB implemented a series of engineering interventions consisting of new tap outlets and PALL tap water end filters as well as holistic factors such as a revised tap cleaning method and appropriate disposal of patient waste water. Breakpoint models indicated the engineering and holistic interventions resulted in a significant (p <0.001) 50% reduction in the number of P. aeruginosa clinical isolates over a year. Here we show the role of waterborne transmission of P. aeruginosa in an ICU cannot be overlooked. We suggest reducing the transmission of waterborne P. aeruginosa involves both holistic and engineering factors.

Dr Mark Garvey, University Hospitals Birmingham NHS Foundation Trust