NHS trust leads the way in battle against superbugs

Frimley Health is leading the way worldwide with a revolutionary system that could help to turn the tide in the battle against superbugs.

The intensive therapy unit (ITU) at FHFT’s Wexham Park Hospital has been completely redesigned to minimise the risks to critically ill patients from water and wastewater of microbes that may also be resistant to most antibiotics. It has involved re-engineering ward facilities and rethinking all procedures that utilise water from an infection prevention perspective.

It is the first ITU in the UK to adopt the new ‘water-safe’ system and the strong evidence it is providing has attracted the attention of world health leaders and other hospitals across the NHS.

Most sinks have been removed from the ward as they are considered a potential source of troublesome bugs that live within the drainage systems, alcohol gel usage has been extended for disinfecting hands instead of washing with soap and water, and waterless systems are used to clean and disinfect patients, equipment and surfaces. 

Robust surveillance has provided evidence that this is safe, sustainable and reduces many types of hospital acquired infection, including antibiotic resistant bacteria that can be very difficult to treat. These practices have been extended across the Trust with engineering works rolled out systematically to the hospital’s Eden Ward, which treats a lot of immunocompromised patients undergoing chemotherapy, and other areas based on risk.

The water-safe system can seem counterintuitive to many in the healthcare world where regular handwashing has become established as an effective way to control infection.

But with levels of antimicrobial resistance (AMR) increasing – caused in part by years of excess use of antibiotics throughout the world and a slowdown of new antibiotics that are being developed – there is growing evidence that sinks and other water sources in certain healthcare settings can spread superbugs that lurk within the pipes and drains.

The Frimley Health team has adapted learning from water-safe units in hospitals in the Netherlands where it was first introduced more than 10 years ago, while incorporating local innovation.

Dr Manjula Meda, consultant microbiologist at Frimley Health and chair of the national Healthcare Infection Society, has been a driving force in the introduction of the new system and gave a keynote presentation at a WHO Europe convention in Budapest earlier this year.

She said:

"We know that the world is facing a crisis in AMR that could knock back advances in medical care by decades. The growing danger from these bugs has proved very difficult to combat as bacteria evolve at a very rapid rate and relying on antibiotic discovery alone has failed to turn the tide on AMR.

“Addressing AMR by prevention through redesign of hospitals and changing practices that we are pioneering at Wexham Park could be one of the ways we start to win the battle and ensure we have effective antibiotics for future generations.”

Frimley Health approved the proposal of Dr Meda and her colleagues to trial the new system, partly in response to an outbreak of a resistant bug called CPE that was proving very difficult to eradicate.

It involved a commitment from the whole ITU team, including housekeeping and estates colleagues, to do things completely differently. This included minimising the amount of water used to care for patients, maximising use of hand gels, and rethinking how drains, sluices, internal rooms and layouts are designed.

Hospital teams from across the UK and as far afield as Japan have visited Wexham’s ITU to find out more. The project has also attracted the attention of the NHS’s national New Hospital Programme (NHP), responsible for delivering 40 new hospitals over the next decade. They are very interested in learning how water-safe care might be built into the designs of future hospitals to ensure they are as hygienic as possible for vulnerable patients.

The effectiveness of the new system and the quality of data it is providing has been helped by support from pathology teams and from monitoring and surveillance systems built into the Trust’s electronic patient record system.

“This is completely changing the way that we think about controlling infection in healthcare environments, particularly where we have a lot of vulnerable patients,” said Dr Meda.

“We have also had such superb support from our estates and facilities teams throughout and we are now in the position of being able to gather medium and longer-term evidence, including the sustainability effects. This hasn’t been done before, so we have a chance to provide further evidence to the world that prevention is in fact better than cure.”