9/
💡Key takeaway: Patient safety demands a zone-based, proactive, multidisciplinary approach to managing both water and wastewater in hospitals.
Redefining “water safety” may be one of the most important moves in the AMR era.

🧵/end

8/
📊 Whether it’s clinical handwash stations, shower design, or cleaning workflows, each part of the system needs integrated thinking.
“Clinically integrated water/wastewater safety” is the new north star—tying engineering, IPC & clinical workflows together.

7/
📉 The authors warn against a reactive mindset. Retrofitting drains after AMR outbreaks is costly—and sometimes impossible.
New builds must proactively bake in safety. Hospitals designed today will serve during peak AMR eras. We can’t afford to get it wrong.

6/
🛠️ The paper suggests renaming Water Safety Groups to Water/Wastewater Safety Groups (you get the idea) —broadening scope to include wastewater hazards, which are often invisible but just as risky.

5/
🚿 Some hospitals have responded with “water-free” or “water-lite” ICUs—removing sinks, switching to wipes, etc.
These aren’t fringe moves—they’re targeted interventions to stop recurring outbreaks when other measures fail. (Personal note: Implementation not so easy!)

4/
🔄 Zone B—the periphery—is often neglected, yet staff interact with it constantly. One ICU study showed only 4% of sink use was for handwashing 🤯
Design flaws here can spread AMR via showers, pantries, even jug-filling.

3/
🧠 The term “water safety” masks critical risk zones. The authors redefine hospital plumbing into 3 zones:

A) Main water system
B) Periphery (e.g. sinks, traps, final 2m of pipe)
C) Main wastewater system

Each zone needs separate oversight & expertise.
#BuiltEnvironment

2/
The authors argue that our traditional idea of “water safety” is outdated—especially in the age of antimicrobial resistance.
They propose a new, more precise framework that accounts for risks from both water and wastewater systems. 🚽🧫
The following are the key points (that I liked) 🧵👇

8/ Bottom line?
This Singapore study offers a real-world, real-cost case for smart PPE deescalation.
🛡️ Safety preserved
💵 Costs down
🌱 Carbon cut
It’s time to reimagine IPC and assess how we protect health workers — and the planet.

6/ The accompanying editorial calls this a “larger imperative.” jamanetwork.com/journals/jam...
We’re not just talking COVID-19 here — it’s a pivot toward sustainable, evidence-aligned PPE use across all of healthcare.
The gowns we use (and toss) daily? They have a carbon footprint too.

5/But it wasn’t just about safety.
Check out the sustainability win:
💥 440,532 disposable gowns saved
♻️ 66,080 kg plastic waste avoided
🌍 398,681 kg CO₂ emissions prevented
💸 ~SGD 454k (USD ~$334k) saved

4/💡Result: No increase in infections.
COVID-19 incidence among staff tracked with community trends.
➕ Median staff-to-community infection ratio actually dropped from 2.6 to 1.5 after PPE deescalation.
Safety? ✔️

3/📊 The study looked at 12 months before & after the policy change at a major hospital campus.
⚕️ >10,000 healthcare staff
🗓️ 24 months of data
Key question: Did COVID-19 cases among staff rise post-change?

2/📍Context:
In Sept 2022, Singapore deescalated PPE guidance for routine COVID-19 care:
From → Gowns, gloves, eye protection & N95
To → Just N95s.
Controversial? Maybe.
But what happened next is worth examining.

Thanks to @kalisvar.bsky.social for his comprehensive overview of everything new in environmental cleaning, surface transmission dynamics, and mopping up MDROs #AntimicrobialResistance

The #ESCMIDGlobal 2025 "Year in Infection Control" symposium starts soon in Hall 1! Chairs Nico Tom Mutters and Ermira Tartari, alongside speakers Andrew James Stewardson and @kalisvar.bsky.social , will review the top papers from the past year, ongoing controversies, and take-home messages.