Hospital water as the source of healthcare-associated infection and antimicrobial-resistant organisms

Abstract

Purpose of reviewDrinking water is considered one of the most overlooked and underestimated sources of healthcareassociated infections (HAIs). Recently, the prevention and control of opportunistic premise plumbing pathogens (OPPPs) in healthcare water systems has been receiving increasing attention in infection control guidelines. However, these fail to address colonization of pathogens that do not originate from source water. Subsequently, this review explores the role of water and premise plumbing biofilm in HAIs. The potential mechanisms of contamination and transmission of antimicrobial-resistant (AMR) pathogens originating both from supply water and human microbiota are discussed. Recent findingsOPPPs, such as Legionella pneumophila, Pseudomonas aeruginosa and Mycobacterium avium have been described as native to the plumbing environment. However, other pathogens, not found in the source water, have been found to proliferate in biofilms formed on outlets devices and cause HAI outbreaks.

Infection prevention and control and related practices in African neonatal units: The Pan-African neonatal care assessment study (PANCAS)

“…When microbiologic data were available, Gram-negative pathogens caused most HAIs and clusters/outbreaks. Notably, a minority of sites used the evidence-based practice of cohorting newborns during clusters/outbreaks to avoid additional transmission to other newborns ( Hayward et al, 2022 ). Furthermore, many relatively narrow spectrum antibiotics used by the sites were consistent with WHO recommendations which may not reflect the susceptibility patterns seen in these countries ( Richard et al, 2001 ).…”

“…However, the video assessments revealed crowding and clutter that could impede environmental cleaning suggesting that efforts to reducing crowding and clutter could improve the effectiveness of cleaning and disinfection. The U.S. Centers for Disease Control and Prevention have also increasingly emphasized safe water practices to reduce HAIs as municipal water can be contaminated by coliform bacteria and hospital pipes may harbor biofilms of potential bacteria and mycobacteria ( Best Practices for Environmental Cleaning ; Decraene et al, 2018 ; Hayward et al, 2022 ). Thus, sterile water is recommended to fill respiratory therapy equipment and prepare formula, but not all sites used sterilized water for these activities.…”

Clinical Issues — February 2023

“…Waterborne pathogens can be transmitted by aerosols, ingestion, direct contact (eg, bathing), or indirect contact (eg, contaminated medical equipment rinsed with tap water, hands of health care personnel) 1 . In a literature review of the sources associated with health care–associated infections and antimicrobial‐resistant organisms, the authors concluded that health care facility water systems are often overlooked and underestimated as a source of health care–associated infections 3 . From January 1, 2014, through December 31, 2017, the Centers for Disease Control and Prevention (CDC)'s Division of Healthcare Quality Promotion completed 620 consultations on health care–associated infections; of these, approximately 21.6% were attributable to water‐related organisms 2 …”

Comparing the Effects of Two Culture Methods to Determine the Total Heterotrophic Bacterial Colony Count in Hospital Purified Water

“…Hospital purified water is widely utilized in clinical medical activities, as well as for the cleaning, disinfection, and sterilization of medical equipment and supplies. Contaminated hospital purified water can pose a risk of nosocomial cross-infections within healthcare facilities [ 1 – 4 ]. At present, the serious microbial contamination of hospital purified water has become a difficult problem faced by hospitals [ 5 ].…”