Article original

Maîtrise de la contamination des fontaines réfrigérantes par Pseudomonas aeruginosa dans un hôpital de gériatrie

Water is essential to the functioning of health facilities, water supply and water for standard care but it can be a source of serious infections in case of contamination, especially for the most fragile patients

Groupe Henri-Mondor, AP-HP, Hôpital Joffre-Dupuytren, 1, rue Eugène Delacroix, 91211 Draveil, France

^∗ Auteur de correspondance : Nadine Sabourin, Cette adresse e-mail est protégée contre les robots spammeurs. Vous devez activer le JavaScript pour la visualiser.

Résumé

Des fontaines réfrigérantes sont installées dans les établissements de santé afin de procurer une eau de boisson rafraichie et désaltérante. Dans ce but, elles sont utilisées par les soignants et par les patients. Le nettoyage de ces fontaines, leur maintenance et leur surveillance font intervenir des professionnels soignants, techniques et les hygiénistes. Dans le cadre d’une gestion rigoureuse et selon réglementation, des analyses bactériologiques sur toutes les fontaines réfrigérantes de l’hôpital sont réalisées pluri-annuellement. Dans cette étude, 3 fontaines sur 26 sont contaminées par Pseudomonas aeruginosa. Cette contamination est problématique et peut entraîner des infections nosocomiales chez les patients les plus fragiles. La recherche des causes de la contamination montre qu’elle ne provient pas du réseau d’eau de l’hôpital et que la fontaine réfrigérante incriminée n’est pas contaminée. Nous avons trouvé que la colonisation par P. aeruginosa s’effectue dans le tuyau de jonction entre le réseau d’eau froide et la fontaine. Les différents moyens de maîtriser cette situation ont été le détartrage, les interventions techniques internes et le changement du tuyau de jonction.

Abstract

The installation of water coolers in hospitals may increase the risks associated with waterborne opportunistic bacteria such as Pseudomonas aeruginosa. This is the third bacteria responsible for nosocomial infections in France (ENP 2006, RAISIN). This study focuses on the positive findings for P. aeruginosa in water coolers before and after corrective actions of the responsible departments and provides the best solutions to avoid contamination by P. aeruginosa of drinking water. Water coolers are installed in the facility Joffre-Dupuytren Hospital, geriatrics, since 2001. First intended only for personal use, they have been extended to patients because of the risk of heatwaves. Cell “réseau eau” has estimated that all the water coolers at the hospital were of danger points. They are all multi analyzed annually. Protocols for cleaning, preventive and curative maintenance, intervention in case of bacteriological test results unsatisfactory for human consumption, are made. A retrospective survey on the results of non-compliant water analysis of water coolers for a period of one year is completed. The positive results with P. aeruginosa are analyzed and the cause of contamination is desired. The result of annual testing on the 26 water coolers for research of P. aeruginosa is non-compliant in 16.1% of cases. After intervention by the technical services and implementation of corrective maintenance, one other fountain have satisfactory test results. The third fountain is replaced and the results remain unsatisfactory. The pipe junction between the fountain and the cold water system is changed and the results become satisfactory. The discussion focuses on the regulation of fountains: they follow the same analysis that water intended for human consumption. There is no regulation against P. aeruginosa in water intended for human consumption at points of use. Although there is no evidence that the normal use of drinking contaminated by P. aeruginosa can be a source of infection in the general population oral but P. aeruginosa can infect immunocompromised persons in the digestive tract. The means of intervention at the hospital involve the hospitality team, the technical services and unit fight against nosocomial infections. Alongside these interventions, we study processes as electromagnetic treatment across the network and the method of hydrodynamic cavitation related to UV which seems ideal and provides water to the point of use bacteria-free, however it does not eliminate bacteria present upstream of the fountain. So, we ca conclude that compliance with all protocols, multi-year analysis and coordination of stakeholders are the solutions to maintain the water quality of water coolers in the hospital bur not sufficient. Hydrodynamic cavitation related to a UV lamp output point of use water coolers appears to be the solution to obtain water level of contamination. Contamination of cold water by P. aeruginosa in health facilities as well as at points of use water coolers, require harmonized regulations like bottled water, because of the fragility of hospitalized patients.