Cleaner Water to Patients

An Industry Insight by Ernest A. Elgin, Nephros

Water reaches patients every day. All tap water has the potential to contain harmful micro-organisms. Hospitals with their multitude of sites where water reaches patients, need to implement a comprehensive system to ensure water purity.

“Hospital-acquired pneumonia is commonly caused by water-borne pathogens”
-Ernest A. Elgin, Nephros

Water is a reservoir for micro-organisms that can cause infections amongst patient and visitor populations. The most common are: Legionella pneumophila, Pseudomonas aeruginosa, Stenotrophomonas maltiphilia, Acinetobacter baumannii, and Aspergillus. All are found in potable water.

Hospital–acquired pneumonia is commonly caused by water-borne pathogens. Immuno-compromised patients in hospitals are at the greatest risk of being negatively impacted with increases in morbidity/mortality, prolonged hospital stays, and obviously elevated costs and legal exposure to the hospital for additional care.

Water is clean when it gets to our facility. True, local municipal water supplies are clean as they leave the source. The issue to manage as a hospital executive is, “What is the quality of the water when it reaches the patient?” There are many variables that have to be considered when evaluating how to maintain the final ‘end-product’ water quality; such as the age, size, renovation, or general construction of the facility.

Current water cleaning systems are comprehensive but do not address all of the scenarios present that enable bio-film formation and therefore enable and proliferate many of the above micro-organisms. Water supplied to hospitals can be checked and treated at multiple points along the way from onsite water towers to mid-way points along the water lines into specific hospital areas.

The critical consideration is to ensure the quality of the water reaching the patient is at the common end-points, which are within the patient rooms themselves. Common end-points include sinks and showers. Realistically, all water sources with the potential for aerosolization need to be considered, especially when they are located near susceptible patient populations.

We have a process for ensuring water quality. There are several water system disinfection modalities. Among the more advanced are: thermal shock, chlorination, source filtration, copper-silver ionization and others. All have considerable literature available through manufacturers and clinical studies to prove their efficacy under specific processes. All do a good job treating the water system at a ‘macro’ level.

Even with one of these systems installed, and proper water system cleaning, a hospital cannot guarantee water leaving a tap is 100 percent free of all potential infection-causing bacteria. The complexity of the system virtually ensures that there will always be areas that cannot be cleaned ‘as well’ or treated frequently enough to prevent bacterial formation. It is this formation within the hospital’s water lines that is part of the problem.

Only ultra-filtration of water, prior to use, ensures that if any contaminant is present, it is filtered and kept from coming in contact with patients. Delivering safe water is the primary goal of all of these efforts. This critical filtration step has to come very near the end of the water line itself where it is delivered to the patient to ensure pathogen-free, biologically pure water is reaching the patient.

Often, hospitals have well-structured and supported protocols for ensuring that water reaching immuno-compromised patient areas is given extra scrutiny but without proper ultra-filtration at the sink and shower you cannot be assured you are properly protecting your high-risk patients. Anything less than 100 percent protection means that there is exposure to harmful bacteria that can be passed along to the patient population.

A plan has to ensure the maximum water purity to be effective. Executive management is responsible for patient safety and hospital financial performance. The reduction and ultimate elimination of hospital-acquired infections (HAIs) is an ever-present objective shared by all. The water supply to any hospital has as its final destination, the patient. When developing a comprehensive HAI program it is critical that the entire system of water supply to the hospital and patient be managed to ensure only safe water reaches the patient from faucets and showers.

Ernest A. Elgin III is President and CEO of Nephros, Inc. He has spent 20 years of his career within the healthcare industry. Most of his time was spent in product and business development. Products he has guided through R&D and commercialization include surgical, therapeutic and diagnostic devices. His business development work includes licensing, M&A, and providing leadership to large and small organizations.