{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,6]],"date-time":"2026-06-06T15:00:31Z","timestamp":1780758031636,"version":"3.54.1"},"reference-count":31,"publisher":"Microbiology Society","issue":"5","license":[{"start":{"date-parts":[[2023,5,31]],"date-time":"2023-05-31T00:00:00Z","timestamp":1685491200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100013898","name":"Milli E\u011fitim Bakanli\u011fi","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100013898","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100012317","name":"University College London Hospitals Biomedical Research Centre","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100012317","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,5,31]]},"abstract":"\n Introduction.<\/jats:bold>\n \n \n Pseudomonas aeruginosa<\/jats:ext-link>\n <\/jats:named-content>\n <\/jats:italic> in healthcare shower waters presents a high risk of infection to immune-suppressed patients; identifying the colonization-status of water outlets is essential in preventing acquisition.<\/jats:p>\n \n Hypothesis\/Gap Statement.<\/jats:bold> Testing frequencies may be insufficient to capture presence\/absence of contamination in healthcare waters between sampling and remediation activities. Standardization of outlets may facilitate the management and control of \n \n P. aeruginosa<\/jats:ext-link>\n <\/jats:named-content>\n <\/jats:italic>.<\/jats:p>\n \n Aim.<\/jats:bold> This study aims to monitor shower waters and drains for \n \n P. aeruginosa<\/jats:ext-link>\n <\/jats:named-content>\n <\/jats:italic> in augmented and non-augmented healthcare settings every 2\u2009weeks for a period of 7 months during remedial actions.<\/jats:p>\n \n Methodology.<\/jats:bold> All shower facilities were standardized to include antimicrobial silver-impregnated showerhead\/hose units, hose-length fixed to 0.8\u2009m and replaced every 3\u2009months. Standard hospital manual decontamination\/disinfection occurred daily. Thermostatic-mixer-valves (TMVs) were replaced and disinfected if standard remediation unsuccessful.<\/jats:p>\n \n Results.<\/jats:bold> Of 560 shower and drain samples collected over 14 time-points covering 7\u2009months, \n \n P. aeruginosa<\/jats:ext-link>\n <\/jats:named-content>\n <\/jats:italic> colonized 40\u200a%(4\/10; non-augmented) and 80\u200a%(8\/10; augmented-care) showers in the first week. For each week elapsed, new outlets became contaminated with \n \n P. aeruginosa<\/jats:ext-link>\n <\/jats:named-content>\n <\/jats:italic> by 18\u201319\u200a% (P<\/jats:italic><0.001) in shower waters (OR=1.19; CI=1.09\u20131.31) and drains (OR=1.18; CI=1.09\u20131.30). \n \n P. aeruginosa<\/jats:ext-link>\n <\/jats:named-content>\n <\/jats:italic> occurrence in shower water was associated with subsequent colonization of the corresponding drain and vice versa (chi-square; P<\/jats:italic><0.001) with simultaneous contamination present in 31\u200a%(87\/280) of areas. TMV replacement was ineffective in eradicating colonisation in ~83\u200a% of a subset (6\/20; three per ward) of contaminated showers.<\/jats:p>\n \n Conclusions.<\/jats:bold> We demonstrate the difficulties in eradicating \n \n P. aeruginosa<\/jats:ext-link>\n <\/jats:named-content>\n <\/jats:italic> from hospital plumbing, particularly when contamination is no longer sporadic. Non-augmented care settings are reservoirs of \n \n P. aeruginosa<\/jats:ext-link>\n <\/jats:named-content>\n <\/jats:italic> and should not be overlooked in outbreak investigations. Antimicrobial-impregnated materials may be ineffective once colonization with \n \n P. aeruginosa<\/jats:ext-link>\n <\/jats:named-content>\n <\/jats:italic> is established beyond the hose and head. Reducing hose-length insufficient to prevent cross-contamination from shower drains. \n \n P. aeruginosa<\/jats:ext-link>\n <\/jats:named-content>\n <\/jats:italic> colonization can be transient in both drain and shower hose\/head. Frequent microbiological monitoring suggests testing frequencies following HTM04-01 guidelines are insufficient to capture the colonization-status of healthcare waters between samples. Disinfection\/decontamination is recommended to minimize bioburden and the effect of remediation should be verified with microbiological monitoring. Where standard remediation did not remove \n \n P. aeruginosa<\/jats:ext-link>\n <\/jats:named-content>\n <\/jats:italic> contamination, intensive monitoring supported justifying replacement of showers and contiguous plumbing.<\/jats:p>","DOI":"10.1099\/jmm.0.001698","type":"journal-article","created":{"date-parts":[[2023,5,31]],"date-time":"2023-05-31T10:17:25Z","timestamp":1685528245000},"source":"Crossref","is-referenced-by-count":12,"title":["Enhanced monitoring of healthcare shower water in augmented and non-augmented care wards showing persistence of Pseudomonas aeruginosa despite remediation work"],"prefix":"10.1099","volume":"72","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4228-1352","authenticated-orcid":false,"given":"\u00d6zge","family":"Yeti\u015f","sequence":"first","affiliation":[{"name":"University College London, Division of Infection and Immunity, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3392-7657","authenticated-orcid":false,"given":"Shanom","family":"Ali","sequence":"additional","affiliation":[{"name":"University College London Hospitals, Clinical Microbiology, UCLH Environmental Research Laboratory, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5935-7907","authenticated-orcid":false,"given":"Kush","family":"Karia","sequence":"additional","affiliation":[{"name":"University College London Hospitals, Clinical Microbiology, UCLH Environmental Research Laboratory, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7830-4563","authenticated-orcid":false,"given":"Paul","family":"Bassett","sequence":"additional","affiliation":[{"name":"Statsconsultancy Ltd, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1109-5650","authenticated-orcid":false,"given":"Peter","family":"Wilson","sequence":"additional","affiliation":[{"name":"University College London Hospitals, Clinical Microbiology, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"345","reference":[{"key":"R1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhin.2013.09.010"},{"key":"R2","doi-asserted-by":"publisher","DOI":"10.1002\/mbo3.391"},{"key":"R3","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.01759-19"},{"key":"R4","article-title":"AMR local indicators. 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