Defining Augmented Care for Pseudomonas Control in Healthcare
Hot and cold water systems present a recognised source of infection risk in any built environment, but the stakes are considerably higher in healthcare settings where patients are already vulnerable. This risk is amplified further in areas providing augmented care, where individuals often have compromised immunity, invasive devices, or complex clinical needs. Understanding what constitutes augmented care is therefore essential, not only from a clinical perspective but also in terms of managing waterborne pathogens such as Pseudomonas aeruginosa, which can readily exploit these high-risk environments.
In this article, we define augmented care and consider where it is typically delivered within hospitals and specialist units. We then explore why patients in these settings are particularly susceptible to P. aeruginosa, before outlining the practical steps required to assess and control risk. This includes the role of targeted risk assessments, water system design considerations, and ongoing monitoring as part of a robust Water Safety Plan, all aimed at reducing the potential for infection in augmented care environments.
A version of this article highlighting the definition of “augmented care” when reviewing the requirements for the control of Pseudomonas in hospital and specialised healthcare environments first appeared in Legionella Control International’s newsletter. To get it in your inbox, sign up here.
Controlling Pseudomonas in augmented care
Water supplies can be a source of waterborne infections no matter what kind of building they are provided in. However, it’s obvious that hospitals and similar healthcare buildings pose a bigger risk in this respect. Every day, many people receive hospital care following an accident, illness, operation, or other situation.
People who are already ill, whether in an acute or chronic sense, are at greater risk of picking up infections. They may also fare worse in fighting off those infections. This is particularly true in situations where individuals are receiving augmented care … but what is the definition of augmented care?
In this guide, we will look more closely at augmented care. We’ll find out what is covered by this term, along with learning more about Pseudomonas aeruginosa, a bacterium that thrives in damp areas. We’ll also cover the steps you must take to control P. aeruginosa in hospitals and other healthcare environments if you are part of the Water Safety Group responsible for doing this.
What is augmented care?
Augmented care in hospitals and specialised healthcare settings refers to a level of care that is more intensive than standard ward care but less than full critical care (ICU). It bridges the gap between routine ward care and intensive care, focusing on early intervention and the prevention of deterioration.
It involves enhanced patient monitoring and support provided to individuals who are at risk of deterioration but do not yet require intensive care.
Where do you find augmented care units in hospitals?
Broadly speaking, patients will receive augmented care if they are immunosuppressed, require organ support, or have significant skin issues such as those seen in burns units. Aside from burns units, patients may receive augmented care in intensive care units, renal units, and neonatal units among other locations. While it can exist in different forms depending on the hospital, you’ll typically find it in:
- High Dependency Units (HDUs)
- Enhanced care bays on wards
- Specialist units (e.g. respiratory, cardiac, stroke units)
- Post-operative recovery areas
What types of patients require augmented care?
Patients who might need augmented care include:
- Patients with worsening infections (e.g. sepsis risk)
- Those needing high-flow oxygen or close respiratory monitoring
- Post-surgical patients with complications
- Patients with unstable vital signs but not requiring ICU
In terms of managing the risks posed by Pseudomonas aeruginosa, it is also wise to consider patients receiving extensive inpatient treatment. This commonly includes situations where someone has one or more lines in situ for a time. This description covers venous lines, catheters, and similar tubes that may be required for an extended period.
What is Pseudomonas aeruginosa?
Pseudomonas is a naturally occurring bacterium often found in water and soil. However, some types, such as Pseudomonas aeruginosa, can make their way into manmade water systems. Indeed, P. aeruginosa is one of the more common bacteria to cause infections in hospitals.
The bacterium is known to cause various infections, affecting the lungs and blood. It can also cause urinary infections. It is also a major risk factor where an individual has an open wound, whether that has occurred through surgery or injury.
Pseudomonas is an opportunistic infection that can be spread through contact between individuals, particularly if hand washing and other infection control measures are not taken. It can also easily spread through contaminated water sources and equipment, such as ventilators and lines used for various purposes, as noted above. This explains why special care must be taken to maintain good water safety practices and infection control in augmented care units.
How dangerous is Pseudomonas aeruginosa?
It should be taken seriously, it is often resistant to antibiotics, so if someone acquires an infection caused by this bacterium, it may be difficult to treat. As always, prevention is the best option, which we’ll come to next.
How to control Pseudomonas in augmented care units?
It is imperative to conduct a Pseudomonas risk assessment that specifically focuses on risks posed by Pseudomonas aeruginosa inside an augmented care unit. This should cover all possible risks that may occur involving contaminated water.
It’s important to recognise that the risk factors could vary according to the specific nature of the augmented care unit in question. For example, burns patients may be more susceptible to skin infections given their injuries. Meanwhile, patients on ventilators with various lines and machines around them would be at risk of infection via those lines.
It’s also wise to consider the available water outlets and whether they are as safe as they can be. In some cases, thermostatic mixing valves (TMVs) are mooted as the preferred option to keep a safe water temperature. This can help ensure bacteria is kept to a minimum.
However, if augmented care is being given in an intensive or critical care unit, patients won’t be able to access those outlets anyway. In this respect, standard taps may prove to be easier to clean and maintain, removing the complexity that can sometimes hinder correct maintenance. It’s a good example of how a specific augmented care location can influence how successful a Pseudomonas risk assessment can be.
The risk assessment should also consider how the water is supplied in such scenarios. For example, using point-of-use filters is safer than merely relying on tap water. Sterile water may also be a better and safer option in some cases.
The risk assessment for Pseudomonas should be supported by detailed schematics, identifying all pipework, outlets, and other parts of the water system in the augmented care unit concerned. Any infrequently used water outlets should be regularly flushed to ensure there is no buildup of scale, debris, or bacteria inside. You should also ensure you correctly take regular water samples to test for the presence of Pseudomonas aeruginosa. Regular testing for P. aeruginosa will confirm whether it is present and if so, to what extent.
Seeking professional advice and support in assessing Pseudomonas risks in augmented care
As noted, the control of Pseudomonas in augmented care units begins by identifying where the risk factors lie. This is done via a Pseudomonas risk assessment, designed to identify all risks present in an augmented care unit, so that proper steps can be taken to reduce or eliminate such risks.
Proper and ongoing risk management should be undertaken by the Water Safety Group (WSG) as part of the Water Safety Plan (WSP). Many WSGs choose to hire an external expert to attend and conduct the risk assessment, to ensure it is done to the highest standards, so nothing is accidentally missed.
If you are seeking help in this area, you can contact us for more information about Pseudomonas risk assessments and how to proceed. Pseudomonas aeruginosa infections can be serious and, in some cases, fatal, especially given the fragile health of those being treated in augmented care settings. Let’s not forget that many such infections do not respond to antibiotics. A risk assessment provides a crucial starting point to ensure all risk factors are either removed or properly dealt with.
Practical, evidence-based Pseudomonas risk management
Ultimately, defining augmented care is about more than terminology … it is about recognising where the highest risks exist and ensuring appropriate controls are in place to protect some of the most vulnerable patients in the healthcare system. Pseudomonas aeruginosa presents a persistent and well-documented challenge in these environments, particularly where water systems, outlets, and clinical practices intersect. A clear understanding of how augmented care area’s function, combined with a detailed and site-specific risk assessment, provides the foundation for effective control.
At Legionella Control International, we support healthcare providers in identifying and managing these risks with a practical, evidence-based approach. From carrying out comprehensive Pseudomonas risk assessments to advising on water system design, monitoring regimes, staff training courses and remedial actions, our focus is on delivering robust, defensible solutions that align with current guidance and best practice. In complex augmented care settings, where there is little margin for error, having the right expertise in place can make a critical difference in safeguarding patient health.
If you have any concerns relating to the control of Pseudomonas or would like to speak with one of our healthcare water specialists, please contact our team on 0330 223 36 86.
