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

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. 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). 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. 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. 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.