Advertisement

Current Infectious Disease Reports

, Volume 2, Issue 6, pp 490–496 | Cite as

Waterborne nosocomial infections

  • Cheryl Squier
  • Victor L. Yu
  • Janet E. Stout
Article

Abstract

Waterborne pathogens cause infections in health-care facilities. Despite guidelines addressing these pathogens, outbreaks and pseudo-outbreaks continue to occur. We reviewed recent reports of infections caused by Pseudomonas aeruginosa, Stenotrophomonas maltophilia, Chryseobacterium species, nontuberculous mycobacteria, and Legionella species. Mycobacterium avium complex (MAC) infection in HIV patients has been linked to hospital water distribution systems; molecular subtyping showed that MAC isolates in patients and hospital water were identical. In immunosuppressed patients, Fusarium infection has been linked to the hospital water distribution system; again molecular subtyping showed that isolates from patients and the water supply were identical. Parasites, especially Cryptosporidium, and viruses have also been implicated in nosocomial infection. Transmission occurs via contact, ingestion, aspiration, or aerosolization of potable water, or via the hands of health-care workers. Interventions designed to interrupt transmission of waterborne pathogens have included the use of antimicrobial handwashes, targeted disinfection of the water supply, and, in high-risk populations, restricting the use of tap water.

Keywords

Water Distribution System Human Immunodeficiency Virus Patient Mycobacterium Avium Complex American National Standard Institute Infect Control Hosp 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References and Recommended Reading

  1. 1.
    Bert F, Maubec E, Bruneau B, et al.: Multiresistant Pseudomonas aeruginosa outbreak associated with contaminated tap water in a neurosurgery intensive care unit. J Hosp Infect 1998, 39:53–62.PubMedCrossRefGoogle Scholar
  2. 2.
    Buttery JP, Alabaster SJ, Heine RG, et al.: Multiresistant Pseudomonas aeruginosa outbreak in a pediatric oncology ward related to bath toys. Pediatr Infect Dis J 1998, 17:509–513.PubMedCrossRefGoogle Scholar
  3. 3.
    Ferroni A, Nguyen L, Pron B, et al.: Outbreak of nosocomial urinary tract infections due to Pseudomonas aeruginosa in a pediatric surgical unit associated with tap-water contamination. J Hosp Infect 1998, 39:301–307.PubMedCrossRefGoogle Scholar
  4. 4.
    Muydermans G, de Smet F, Pierard D, et al.: Neonatal infection with Pseudomonas aeruginosa associated with a water-bath used to thaw fresh frozen plasma. J Hosp Infect 1998, 39:309–314.CrossRefGoogle Scholar
  5. 5.
    Matyas B: Deadly Pseudomonas strain kills 4 NICU infants. Hosp Infect Control, 1997, 164–169.Google Scholar
  6. 6.
    Weber DJ, Rutala WA, Blanchet CN, et al.: A source of patient colonization with Stenotrophomonas maltophilia. Am J Infect Control 1999, 27:59–63.PubMedCrossRefGoogle Scholar
  7. 7.
    Verweij PE, Meis JF, Christmann V, et al.: Nosocomial outbreak of colonization and infections with Stenotrophomonas maltophilia in preterm infants associated with contaminated tap water. Epidemiol Infect 1998, 120:251–256.PubMedCrossRefGoogle Scholar
  8. 8.
    De Schuijmer J, Vammeste M, Vannecchoutte M, Verschraegen, G: Chryseobacterium in a burn unit [abstract]. In Proceedings of the 4th International Conference of the Hospital Infection Society, Edinburgh, Scotland. 1998; Abstract P.2.5.5.Google Scholar
  9. 9.
    Carson LA, Bland LA, Cusik LB, et al.: Prevalence of non-Tuberculosis mycobacteria in water supplies of hemodialysis centers. Appl Environ Microbiol 1998, 54:3122–3125.Google Scholar
  10. 10.
    Kauppinen J, Nousiainine T, Jantunen E, et al.: Hospital water supply as a source of disseminated Mycobacterium fortuitum infection in leukemia patient. Infect Control Hosp Epidemiol 1999, 20:343–345.PubMedCrossRefGoogle Scholar
  11. 11.
    Brook KL, Dauenhauer SA, Fox RK, et al.: Pseudo-epidemic of Mycobacterium kanasii associated with the hospital’s water system [abstract]. Am J Infect Control 1998, 26:161.Google Scholar
  12. 12.
    von Reyn CF, Maslow JN, Barber TW et al.: Persistent colonisation of potable water as a source of Mycobacterium avium infection in AIDS. Lancet 1994, 343:1137–1141. This is a groundbreaking article documenting colonization of the hospital water system as a source of M. avium complex in the HIV patient.CrossRefGoogle Scholar
  13. 13.
    Singh N, Yu VL: Potable water and MAC in HIV patient: Is prevention possible? Lancet 2000, 343:1110–1111.CrossRefGoogle Scholar
  14. 14.
    Stout JE, Yu VL, Vickers RM, et al.: Ubiquitousness of Legionella pneumophila in the water supply of a hospital with endemic Legionnaires’ disease. N Engl J Med 1982, 36:466–468.CrossRefGoogle Scholar
  15. 15.
    Fiore AE, Butler JC, Emori TG, et al.: A survey of methods to detect nosocomial Legionellosis among participants in the National Nosocomial Infectious Surveillance System. Infect Cont Hosp Epidemiol 1999, 20:412–416. This CDC survey documents that laboratory methodology for the diagnosis of nosocomial legionellosis is woefully inadequate, and that cases are being overlooked.CrossRefGoogle Scholar
  16. 16.
    Kool JL, Bergmire-Sweat D, Butler JC, et al.: Hospital characteristics associated with colonization of water systems by Legionella and risk of nosocomial Legionnaires’ disease: a cohort study of 15 hospitals. Infect Control Hosp Epidemiol 1999, 20:798–805.PubMedCrossRefGoogle Scholar
  17. 17.
    Lepine LA, Jernigan DB, Butler JC, et al.: A recurrent outbreak of nosocomial Legionnaire’s disease detected by urinary antigen testing: evidence for long-term colonization of a hospital plumbing system. Infect Control Hosp Epidemiol 1998, 19:905–910.PubMedGoogle Scholar
  18. 18.
    Yu VL: Resolving the controversy on environmental cultures for Legionella. Infect Cont Hosp Epidemiol 1998, 19:893–897.CrossRefGoogle Scholar
  19. 19.
    Allegheny County Health Department: Approaches to Prevention and Control of Legionella Infection in Allegheny County Health Care Facilities. edn 2. Pittsburgh: Allegheny County Health Department; 1997:1–15.Google Scholar
  20. 20.
    Centers for Disease Control: Guidelines for Prevention of Opportunistic Infections in Bone Marrow Transplant Recipients. Federal Register 1999, 64:48184.Google Scholar
  21. 21.
    Lin YE, Vidic RD, Stout JE, et al.: Legionella in water distribution systems. J Amer Water Works Assoc 1998, 90:112–121.Google Scholar
  22. 22.
    Vanden Bergh MFQ, Verweij PE, Voss A: Epidemiology of nosocomial fungal infections: invasive aspergillosis and the environment. Diagn Microbiol Infect Dis 1999, 34:221–227. This is an excellent review of the environmental and clinical epidemiology of hospital-acquired aspergillosis.CrossRefGoogle Scholar
  23. 23.
    Anaissie EJ, Monson TP, Penzak SR, Stratton SL: Opportunistic fungi recovered from hospital water systems [abstract]. In Proceedings of the 37th Annual Meeting of the Infectious Disease Society of America, Toronto. 1997; Abstract J-93.Google Scholar
  24. 24.
    Anaissie EJ, Kuchar R, Rex JH, et al.: The hospital water system as a reservoir of Fusarium [abstract]. In proceedings of the 37th Interscience Conference on Antimicrobial Agents and Chemotherapy, Toronto. 1997; Abstract J-94.Google Scholar
  25. 25.
    Anaissie EJ, Boutati H: Fusarium, a significant emerging pathogen in patients with hematological cancer: ten years experience [abstract]. In Proceedings of the 37th Interscience Conference on Antimicrobial Agents and Chemotherapy, Toronto. 1997; Abstract J-87.Google Scholar
  26. 26.
    Levy DA, Bens MS, Craun GF, et al.: Surveillance for Waterborne Disease Outbreaks—United States 1995–1996. MMWR CDC Surveill Summ 1998, 7:1–33.Google Scholar
  27. 27.
    Schvoerer E, Bonnet F, Dubois V, et al.: A hospital outbreak of gastroenteritis possibly related to the contamination of tap water by a small round structured virus. J Hosp Infect 1999, 43:149–154.PubMedCrossRefGoogle Scholar
  28. 28.
    Cordes LG, Wiesenthal AM, Gorman GW, et al.: Isolation of Legionella pneumophila from hospital showerheads. Ann Intern Med 1981, 94:195–197.PubMedGoogle Scholar
  29. 29.
    Breiman R, Fields B, Sanden G, et al.: Association of shower use with Legionnaires’ disease: possible role of amoebae. JAMA 1990, 263:2924–2926.PubMedCrossRefGoogle Scholar
  30. 30.
    Helms CM, Massanari R, Zeiter Setal: Legionnaires’ disease associated with a hospital water system: a cluster of 24 nosocomial cases. Ann Intern Med 1983, 99:172–178.PubMedGoogle Scholar
  31. 31.
    Blatt SP, Parkinson MD, Pace E, et al.: Nosocomial Legionnaires’ disease: aspiration as a primary mode of transmission. Am J Med 1993, 95:16–22.PubMedCrossRefGoogle Scholar
  32. 32.
    Bollin GE, Plouffe JF, Para MF, et al.: Legionella pneumophila generated by shower heads and hot water faucets. Appl Environ Microbiol 1986, 50:1128–1131.Google Scholar
  33. 33.
    Newson SWB: Hospital infection from contaminated ice. Lancet 1968, 2:620–622.CrossRefGoogle Scholar
  34. 34.
    Stamm WE, Colella JJ, Anderson RL, et al.: Indwelling arterial catheters as a source of nosocomial bacteremia: an outbreak caused by Favobacterium species. N Engl J Med 1975, 292:1099–1102.PubMedCrossRefGoogle Scholar
  35. 35.
    Brennen C, Stout JE, Muder RR: Legionella on ice: ice as a source for nosocomial Legionnaires’ disease [abstract]. In Proceedings of the Annual Meeting of the Society for Healthcare Epidemiology of America, San Francisco, CA. 1999; Abstract 70.Google Scholar
  36. 36.
    Ravn P, Lundgren JD, Kjaeldgaard P, et al.: Nosocomial outbreak of cryptosporidiosis in AIDS patients. Br Med J 1991, 302:227–280.CrossRefGoogle Scholar
  37. 37.
    Manangan LP, Anderson RL, Arduino MJ, et al.: Sanitary care and maintenance of ice-storage chests and ice-machines in health care facilities. Am J Infect Control 1998, 26:111–112.PubMedCrossRefGoogle Scholar
  38. 38.
    American National Standards Institute: Standard for Emergency Shower and Eyewash Equipment (ANSI Z358.1-1998). Washington, DC: American National Standards Institute; 1998. Available on-line: http://web.ansi.org/default.aspGoogle Scholar
  39. 39.
    Rutala WA, Weber DJ: Water as a reservoir of nosocomial pathogens. Infect Control Hosp Epidemiol 1997, 18:609–616. This article provides a concise and informative review of nosocomial infections related to waterborne pathogens.PubMedCrossRefGoogle Scholar
  40. 40.
    Stout JE, Yu VL: Current concepts: legionellosis. N Engl J Med 1997, 337:682–687.PubMedCrossRefGoogle Scholar
  41. 41.
    Yu VL: Could aspiration be the major mode of transmission for Legionella? Am J Med 1993, 95:13–15.PubMedCrossRefGoogle Scholar

Copyright information

© Current Science Inc 2000

Authors and Affiliations

  • Cheryl Squier
    • 1
  • Victor L. Yu
    • 1
  • Janet E. Stout
    • 1
  1. 1.Infectious Disease Section 111E-UVA Pittsburgh Healthcare SystemPittsburghUSA

Personalised recommendations