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Provision of safe drinking water immunocompromised patients.

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VOL: 101, ISSUE: 08, PAGE NO: 51

Immunocompromised patients are at risk from pathogenic microorganisms in drinking water. However, until recently there has been a lack of concise guidelines on the provision of safe drinking water for such patients.

Immunocompromised patients are at risk from pathogenic microorganisms in drinking water. However, until recently there has been a lack of concise guidelines on the provision of safe drinking water for such patients.

Before September 2004 - when The Yorkshire Cancer Network (2004) launched its guidelines, The Provision of Safe Drinking Water for Cancer Patients with Immunocompromise - UK guidelines had focused mainly on ensuring drinking water was free of Cryptosporidium hominis (previously C. parvum) and did not focus on preventive measures against Gram-negative bacteria or fungal pathogens such as Aspergillus (Boucher, 1998).

This incomplete guidance led to widespread disparity in the level and type of protection implemented by different hospitals.

The new guidelines are based on a research study by Hall et al (2004) that compared practice in 10 NHS trusts across Yorkshire and Humberside. The study reported on water quality and control measures in 14 separate units in these trusts. Nine provided only tap water to all patients. Five units used cooled, boiled water, sterile water, or carbonated water, whereas no unit provided filtered water. In 10 units, patients were allowed to consume their own potable water, but no unit provided written advice to patients on this.

The guidelines comment on the various options, including untreated tap water, boiled tap water, sterile bottled water, commercially available bottled water, and filtered tap water.

Each option was assessed according to measurable criteria, such as microbiological safety, preparation methods, the risk to health care workers, patients' right to confidentiality, and cost-effectiveness.

They do not recommend cooled, boiled water because of the risk to health care personnel from scalding. Bottled water is not considered to be a viable alternative because of the heavy cost implications as well as issues over the microbiological quality of some types of product.

It is obvious that some form of treated water should be made available to immunocompromised cancer patients. A one-month trial of commercially produced in-line disposable water filters (Pall Medical) was conducted in two wards at The Leeds Teaching Hospitals NHS Trust.

At the end of the trial, the ward staff, who had previously provided cooled, boiled water for immunocompromised patients, were impressed by the devices and the time savings they offered, as well as their ability to create a safer working environment. The protocol for changing filters when time-expired was followed without difficulty (Hall et al, 2004).

The study concluded that filtered water offers these patients the best protection.

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