EC 08 - Describing a Risk Assessment Stratified by Environmental and Patient Risks for a Hospital Water Management Plan

Tuesday, June 27, 2023

10:15 AM – 10:35 AM

Location: W103 A/B; Orange County Convention Center

CE: 0.33

CNE Credits: 0.33
CME Credits: 0.33

Presenter(s)

Monica L. Monteon, MS, CIC (she/her/hers)

Sr. Infection Control Practitioner
Children's National Hospital
Silver Spring, Maryland

Disclosure(s): No financial relationships to disclose

PDF

Co-Author(s)

RT

Regan Trappler, MPH, RN, CIC

Washington, District of Columbia
DL

Deena Levey, RN, MPH

Senior Infection Control Practitioner
Children's National Health System
Washington, District of Columbia
ML

Michelle A. Liberty, BSN, RN, CPN (she/her/hers)

Infection Control Assistant (RN)
Children's National Hospital
Laurel, Maryland
AL

Annette Lee, MPH (she/her/hers)

Infection Control Assistant
Children's National Hospital
Xiaoyan Song, PhD, MBBS

Director
Children's National Health System
Washington, District Of Columbia

Moderator(s)

Mohamed N. Elhadidi, Msc, MBA,FISQua,CIC,LTC-CIP (he/him/his)

Chief of infection control
Dallah healthcare
Riyadh

Disclosure(s): No financial relationships to disclose

Co-Moderator(s)

Marissa Broadley, MPH, MSEd, RN, CIC, CPHQ, CPPS, LSSGBH (she/her/hers)

Director, Infection Prevention
Albany Med Health System - Saratoga Hospital
Saratoga Springs, New York

Disclosure(s): No financial relationships to disclose

Background: The development of a water management plan (WMP) is often left to an outside contractor in coordination with a hospital’s facilities department. This could miss the importance of accounting for specific waterborne infection risks inherent in different patient populations. This study presents a risk assessment (RA) for a WMP stratified by both patient and environmental risk factors (RFs).

Methods: In 2017, Infection Prevention (IP) at a major Mid-Atlantic pediatric hospital partnered with the facility department to assess the potable water system supplying inpatient units (IP-Us). Using this information and patient population characteristics in each IP-U, IP developed a RA for waterborne infections stratified by environmental and patient RFs. Environmental RFs included distance from the main water line, likelihood of water usage, and space vacancy. Patient RFs included immunocompetency, use of invasive lines, and risk of exposure to water. The presence of each RF was assigned points. The sum of the environmental RF points was multiplied by the sum of the patient RF points to designate a score. A higher score indicated a higher risk necessitating routine water testing. Threshold values to trigger corrective actions were determined by the IP and WMP committees.

Results: Of the 12 IP-Us in the RA, five were identified as high risk. Water in these areas was tested monthly for chlorine levels and semiannually for legionella and total Heterotrophic Plate Count (HPC). Instances of decreased chlorine levels or elevated HPC have triggered flushing and additional testing; however, since 2017, no Legionella species of concern have been detected. Additionally, there have been no bloodstream infections due to non-tuberculosis mycobacterium since two were identified in early 2017.

Conclusions: An RA accounting for both environmental and patient RFs in a WMP permits hospitals to focus limited resources on IP-Us servicing patients at high risk for infections due to waterborne pathogens.

Learning Objectives:

Articulate the importance of Infection Control involvement in a hospital water management plan.
Recognize the importance of accounting for specific waterborne infection risks inherent in different patient populations.
Apply Infection Control expertise to the development of risk assessment for a water management plan for the facility.