BALTIMORE — According to a study by Johns Hopkins Hospital, hands-free electronic faucets harbor more germs than manual faucets. The culprit has been tentatively identified as the inner workings of hands-free faucets, which have more internal parts and pieces than manual faucets.
Plumbing manufacturers greeted the study with a degree of alarm and consternation. Indeed, the results of the study, detailed only in a press release, leave more questions than answers. Plumbing manufacturers have yet to see the protocol for the study — how much Legionella was there and where, was it being aerosolized and was it in concentrations harmful to human health? Johns Hopkins said it has removed the electronic faucets from patient care areas but not from public restrooms.
“Newer is not necessarily better when it comes to infection control in hospitals, especially when it comes to warding off potential hazards from water-borne bacteria, such as Legionella species,” said senior study investigator and infectious disease specialist Lisa Maragakis, M.D., M.P.H. “New devices, even faucets, however well intentioned in their make-up and purpose, have the potential for unintended consequences, which is why constant surveillance is needed,” said Maragakis, director of hospital epidemiology and infection control at Hopkins Hospital and an assistant professor at the Johns Hopkins University School of Medicine.
Although the faucets cut daily water consumption by well over half, Johns Hopkins researchers identified Legionella growing in 50% of cultured water samples from 20 electronic faucets in or near patient rooms on three different inpatient units, but in only 15% of water cultures from 20 manual faucets in the same patient care areas. Weekly water culture results also showed half the amount of bacterial growth of any kind in the manual faucets than in the electronic models.
“Plumbing Manufacturers International became aware of the Johns Hopkins study on the use of hands-free faucets in hospitals via the news media on March 31,” Executive Director Barbara Higgens said in a statement. “We have reached out to Dr. Lisa Maragakis, M.D., M.P.H., senior study investigator and infectious disease specialist at Johns Hopkins, to obtain a copy of the study for our review and input. Without having seen the study, it is difficult for us to identify how, if at all, their findings apply to the products our members manufacture. We can say with confidence, however, that our products meet the highest industry standards and that hands-free faucets have been safely in use around the world for decades, and have provided many benefits, including water conservation and minimizing the spread of germs from contact. We constantly seek to improve industry standards and performance and look forward to working with the team at Johns Hopkins to review and discuss their findings.”
Jeremy Cressman, vice president and general manager of American Standard’s Commercial Business Unit, told CONTRACTOR that plumbing manufacturers and other stakeholders, including engineers, code officials and test labs, will meet in June at the suburban Chicago headquarters of the American Society of Plumbing Engineers. The group will try to figure out a way to address the issue, a difficult task considering how little the industry knows about the Johns Hopkins study.
Cressman noted that the design of a faucet could possibly affect its susceptibility to contamination. Among the reasons:
· Solenoid valves with large surface areas and rubber components that might provide “food” for bacteria.
· Untreated pre-installation/manufacturer testing water remaining in the units.
· Hosing or stainless supplies with rubber linings that would serve as a host location for biofilm.
· Stagnant water remaining in a faucet spout, housing or outlets.
· Low water flow-rates that decrease the flushing ability of the faucet.
Cressman also directed CONTRACTOR to a variety of epidemiological studies of hospital faucets that arrived at conflicting conclusions. A study in the journal Infection Control and Hospital Epidemiology compared periodically super-heating a hospital hot water system versus copper-silver ionization systems and concluded that copper-silver ionization is more effective at killing Legionella in plumbing.
Because the user does not have to touch the faucet, Cressman noted that hands-free faucets have been a major contributor toward minimizing hospital-acquired infections.
Johns Hopkins facilities engineers, as a result of the study that was conducted over a seven-week period from December 2008 to January 2009, removed all 20 newer faucets from patient care areas and replaced them with manual types. A hundred similar electronic faucets are also being replaced throughout the hospital, and hospital leadership elected to use manual faucets — some 1,080 of them — in all patient care areas in the new clinical buildings currently under construction at Johns Hopkins’ East Baltimore campus. The new buildings are set to open in 2012.
Chicago Faucets, manufacturer of the faucets at Johns Hopkins, pointed out that, “Bacteria resulting from a contaminated system grew in both the manual and electronic faucets tested in the study; neither of the two faucet types was bacteria-free. The conclusions of the Johns Hopkins research, therefore, made in isolation of other evidence, may be misconstrued by the general public. Removing electronic faucets from clinical areas may be an over-reaction.”
PMI has requested a copy of the study, along with any supporting methodologies. Higgens also said that the group wanted to work with Johns Hopkins researchers to study this issue, to ensure the safest possible plumbing products and technology are used. ASPE has likewise requested the detailed results and is coordinating the June meeting of stakeholders from the plumbing community.
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