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Banning hands-free faucets: Is Hopkins throwing the bathwater out with the bathwater?

I hope everyone enjoyed SHEA.  Overall, a good meeting with good weather and good science.  I pinch-hit as a moderator for a hand-hygiene session on Saturday.  The original moderator (i.e. Mike Edmond, have you heard of him??) was scheduled to moderate two sessions at the same time and for some reason wasn't able to pull it off.  ;)

There were interesting studies presented in the session including an abstract highlighting iScrub, which Dan has mentioned before.  One particular abstract garnered a lot of press attention - I'm not used to hearing about data in the morning newspaper before the abstract is presented, for example. The study was conducted by Emily Snydor, Lisa Maragakis and colleagues at Johns Hopkins Hospital and aimed to determine the safety of touchless water faucets in their hospital.  They compared 20 newly installed automatic faucets with 20 old standard faucets and found that 50% of the automatic faucets had 15% of standard faucets were contaminated with Legionella. After chlorine dioxide, 29% of the automatic faucets and 7% of standard faucets were still contaminated with Legionella.  Hopkins is now removing all of the automatic faucets from their facility.

Some thoughts: 1) It appears that Legionella is a problem in their system and the automatic faucets are only part of the problem.  Removing them isn't enough.  2) The faucets in the study were not installed at the same time since the automatic faucets were new and the standard faucets were likely years old - could biofilm play a role here?  3) Not all automatic faucets would be the same, perhaps different designs would have different risks.  4) What about other pathogens?  How do you balance lower risk of C. diff or acinetobacter with touchless faucets compared to Legionella?  5) Could the faucets be "reprogrammed" or designed to allow flow of the stagnant water prior to contact with the HCW hands?  This might reduce one benefit of these automatic faucets since they do save a lot of water.

What do you guys think? Is this enough data to ban automatic faucets in hospitals? My other concern is that this study will be misinterpreted and people will become afraid of automatic faucets in places such as airports.  I doubt the Legionella risk in airports outweighs the influenza risk, for example.

NBC - Dallas article, March 31, 2011
VOA article, April 5, 2011
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  1. Dan DiekemaApril 7, 2011 at 11:28 AM

    We had similar issues with touchless faucets at Iowa, all related to Legionella. I think the problems were twofold, and related: (1) the presence of a small amount of stagnant water potentially serving as a amplifier between uses, or when the room was unoccupied, and (2) a seemingly ridiculous inability to "flush" those peripheral sites to allow adequate chlorine dioxide concentrations to reach the distal ends. You can just turn on a regular faucet and let it run, but for some reason these couldn't be programmed to run continuously, and we didn't want to have to hire people to stand and wave their hands in front of each faucet repeatedly.

    I agree that both of these issues should be amenable to a simple redesign (and maybe there are already such faucets out there).

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  2. MommarazziApril 11, 2011 at 3:42 PM

    Here is the joint APIC_ASHE Statement- The logic is consistent with both of your observations.

    http://www.apic.org/Content/NavigationMenu/PracticeGuidance/ConstructionIssues1/APIC_ASHE_Statement_electronic_faucets.pdf

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  3. VictoryperfectMay 7, 2011 at 2:45 AM

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