Water Management In Healthcare Institutions And How To Prevent Infections. Waterborne pathogens might get to patients through many ways of transmission. Colonization of healthcare facility water distribution systems can happen in the distal water outlets, in the proximal infrastructure, or both. Infections with waterborne organisms like Legionella, Pseudomonas, mycobacteria, and others are the source of significant mortality and morbidity, especially in immunocompromised patients. Health care institutions and hospitals should set up prospective water safety schemes which take into account precautionary measures because precaution is preferable to remediation of contaminated hospital waterworks. Whole-genome sequencing might give more informative epidemiologic data to connect patient infections with hospital water isolates.
Are they preventable?
Hospital water safety is a main priority and constant challenge for healthcare epidemiologists, administrators, engineers, and safety officers. Waterborne infections cause significant mortality and morbidity, however, some are preventable. As with any other healthcare-associated infections, the occurrence of nosocomial waterborne infections undermines public trust in healthcare institutions. Pathogens like nontuberculous mycobacteria and Legionella can colonize the outlets of hospital waterworks or the deep infrastructure of healthcare facilities, whilst molds and other Gram-negative bacteria tend to stick to biofilms at or close to the distal points of use. Legionella outbreaks are completely avoidable 90% of the times through a regular Legionnaires risk assessment and in this article, we will discuss the frequent routes of transmission.
Transmission routes of water pathogens
Waterborne infections can happen from distal (points of use) or proximal (central pipes) contamination of the hospital waterworks. Hospital and municipal tap water aren’t expected to be free of pathogens, however municipal water undergoes routine microbiological surveillance to guarantee safe levels of significant community pathogens like coliform bacteria. Even though contaminated municipal water can be the source of outbreaks which affect immunocompromised patients in healthcare environments, contamination of hospital water generally happens inside the infrastructure of the healthcare institution. Bacteria that wouldn’t sicken most users of drinkable water in the community might affect hospitalized patients due to the immunosuppression, underlying conditions and the presence of invasive devices. Waterborne pathogens can be spread in several ways. Here are some examples of the different ways of transmission:
- Aerosol transmission directly to patients from water: aerosol from a room or shower humidifier, cooling tower, or aspiration by the patients when they drank the water
- Transmission indirectly from fomites which had contact with contaminated water: linens and bath equipment; inappropriate use of nonsterile water for tasks which require higher measures of carefulness, like tracheostomy/oral care of ventilated patients and rinsing of respiratory therapy or endoscopic equipment in tap water
- Exposure to the Water Management In Healthcare of implanted devices (for instance bathing with a central venous catheter incorrectly covered)
- Transmission on the hands of healthcare staff: failure to carry out hand hygiene after contact with patients affected by waterborne organisms or a contaminated environment; splashback from contaminated sink drains; handwashing with contaminated water.
All of the above practices or imperfections represent opportunities for precaution through healthcare institutions and hospital policies, monitoring and education of healthcare staff practices, and correct maintenance and cleaning of equipment. The exact route of transmission is most of the time unknown, even when infections can be connected to a water source.