Maintaining Hydrotherapy Systems to Enhance Infection Prevention and Patient Safety

Session Description: Burn patients are highly susceptible to infections due to open wounds. Hydrotherapy plays a crucial role in caring for burn patients. Recently, we identified that the internal water pathway of our hydrotherapy system was not being disinfected per hospital policy. Analyzing heterotrophic plate counts of the water delivered through the hydrotherapy equipment, we found bacterial counts above the acceptable drinking water standard of 500 colony forming units per milliliter.
Initial actions included cleaning accessible parts and instituting weekly disinfection with chlorhexidine gluconate soap. These measures did not sufficiently or consistently reduce bacterial counts. We hypothesized that the internal water path may be affected by the presence of biofilm.
Even after plastic hosing was replaced, bacterial counts persisted. Each hose had a spray nozzle made of brass and stainless steel at the end. Disassembling and cleaning these nozzles with a 1:10 bleach solution, followed by flushing for 1 minute, resulted in the first samples meeting acceptable limits.
These multi-step efforts significantly improved our hydrotherapy system's safety, ensuring bacterial counts within acceptable standards and enhancing patient care. Our work underscores the importance of rigorous infection control practices such as flushing and equipment maintenance as well as the need for continuous monitoring and assessing ongoing improvement opportunities.
Moving forward, we plan to clean and disinfect less accessible parts of the system with professional assistance, create a preventative maintenance schedule, and include information about this equipment in our onboarding of new employees. We believe the water provided through this system can be as clean as all other points of water access in our hospital.
By sharing our experience, we aim to highlight the challenges and solutions in maintaining hydrotherapy systems or other complex water delivery equipment, emphasizing the importance of diligent infection control water management practices in healthcare settings.