Managing water safety in healthcare. Part 1 – Strategies and approaches for waterborne pathogen control
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Chief Sanitary Inspectorate, Warsaw, Poland
Institute of Haematology and Transfusion Medicine, Warsaw, Poland
Independent Laboratory of Molecular Biology, Institute of Rural Health, Lublin, Poland
Department of Public Health, University of Information Technology and Management, Rzeszow, Poland
Ann Agric Environ Med. 2012;19(3):395-402
Summaries in 2 parts are presented from a conference held in London at the Royal Society for Public Health on 16-17 May 2012, on the latest developments in dealing with waterborne hospital-acquired infections (nosocomial), from the UK perspective. Also included were some views from continental Europe. The first part, focuses on management strategies and plans that are either in use or recommended by domestic/international guidelines, such as the WHO, for prevention, control and risk assessment of disease outbreaks resulting from the presence of these pathogenic microorganisms in water appliances/supplies. Various solutions are discussed, some more effective than others, but all require a comprehensive strategy and technical expertise run by properly trained and dedicated professionals.
Binks PR, Nicklin S, Bruce NC. Degradation of hexahydro-1,3,5-trinitro-1,3,5-triazine (RDX) by Stenotrophomonas maltophilia PB1. Appl Environ Microbiol. 1995; 61(4): 1318-22.
Britt AJ, Bruce NC, Lowe CR. Identification of a cocaine esterase in a strain of Pseudomonas maltophilia. J Bacteriol. 1992; 174(7): 2087-94.
Kerr KG, Snelling AM. Pseudomonas aeruginosa: a formidable and ever-present adversary. J Hosp Infect. 2009; 73(4): 338-44.
Hidron AI, Edwards JR, Patel J, Horan TC, Sievert DM, Pollock DA, Fridkin SK; National Healthcare Safety Network Team; Participating National Healthcare Safety Network Facilities.NHSN annual update: antimicrobial-resistant pathogens associated with healthcare-associated infections: annual summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2006-2007. Infect Control Hosp Epidemiol. 2008; 29(11): 996-1011.
Souli M, Galani I, Giamarellou H. Emergence of extensively drug-resistant and pandrug-resistant Gram-negative bacilli in Europe. Euro Surveill. 2008; 13(47). pii: 19045.
Hanberger H, Arman D, Gill H, Jindrák V, Kalenic S, Kurcz A, Licker M, Naaber P, Scicluna EA, Vanis V, Walther SM. Surveillance of microbial resistance in European Intensive Care Units: a first report from the Care-ICU programme for improved infection control. Intensive Care Med. 2009; 35(1): 91-100.
Beno P, Krcmery V, Demitrovicova A.Bacteraemia in cancer patients caused by colistin-resistant Gram-negative bacilli after previous exposure to ciprofloxacin and/or colistin. Clin Microbiol Infect. 2006; 12(5): 497-8.
Verweij PE, Meis JF, Christmann V, Van der Bor M, Melchers WJ, Hilderink BG, Voss A. Nosocomial outbreak of colonization and infection with Stenotrophomonas maltophilia in preterm infants associated with contaminated tap water. Epidemiol Infect. 1998; 120(3): 251-6.
Eckmanns T, Oppert M, Martin M, Amorosa R, Zuschneid I, Frei U, Rüden H, Weist K. An outbreak of hospital-acquired Pseudomonas aeruginosa infection caused by contaminated bottled water in intensive care units. Clin Microbiol Infect. 2008; 14(5): 454-8.
Naze F, Jouen E, Randriamahazo RT, Simac C, Laurent P, Blériot A, Chiroleu F, Gagnevin L, Pruvost O, Michault A.Pseudomonas aeruginosa outbreak linked to mineral water bottles in a neonatal intensive care unit: fast typing by use of high-resolution melting analysis of a variable-number tandem-repeat locus. J Clin Microbiol. 2010; 48(9): 3146-52.
Lucero CA, Cohen AL, Trevino I, Rupp AH, Harris M, Forkan-Kelly S, Noble-Wang J, Jensen B, Shams A, Arduino MJ, LiPuma JJ, Gerber SI, Srinivasan A. Outbreak of Burkholderia cepacia complex among ventilated pediatric patients linked to hospital sinks. Am J Infect Control. 2011; 39(9): 775-8.
Wong V, Levi K, Baddal B, Turton J, Boswell TC. Spread of Pseudomonas fluorescens due to contaminated drinking water in a bone marrow transplant unit. J Clin Microbiol. 2011; 49(6): 2093-6.
Durojaiye OC, Carbarns N, Murray S, Majumdar S. Outbreak of multidrug-resistant Pseudomonas aeruginosa in an intensive care unit. J Hosp Infect. 2011; 78(2): 154-5.
Yapicioglu H, Gokmen TG, Yildizdas D, Koksal F, Ozlu F, Kale-Cekinmez E, Mert K, Mutlu B, Satar M, Narli N, Candevir A. Pseudomonas aeruginosa infections due to electronic faucets in a neonatal intensive care unit. J Paediatr Child Health. 2012; 48(5): 430-4.
Vallés J, Mariscal D, Cortés P, Coll P, Villagrá A, Díaz E, Artigas A, Rello J. Patterns of colonization by Pseudomonas aeruginosa in intubated patients: a 3-year prospective study of 1,607 isolates using pulsed-field gel electrophoresis with implications for prevention of ventilator-associated pneumonia. Intensive Care Med. 2004; 30(9): 1768-75.
Rogues AM, Boulestreau H, Lashéras A, Boyer A, Gruson D, Merle C, Castaing Y, Bébear CM, Gachie JP.Contribution of tap water to patient colonisation with Pseudomonas aeruginosa in a medical intensive care unit. J Hosp Infect. 2007; 67(1): 72-8.
Trautmann M, Halder S, Hoegel J, Royer H, Haller M.Point-of-use water filtration reduces endemic Pseudomonas aeruginosa infections on a surgical intensive care unit. Am J Infect Control. 2008; 36(6): 421-9.
Hayette MP, Christiaens G, Mutsers J, Barbier C, Huynen P, Melin P et al. Filamentous fungi recovered from the water distribution system of a Belgian university hospital. Med Mycol. 2010; 48(7): 969-74.
Boyer A, Doussau A, Thiebault R, Venier AG, Tran V, Boulestreau H et al. Pseudomonas aeruginosa acquisition on an intensive care unit: relationship between antibiotic selective pressure and patients’ environment. Crit Care. 2011; 15(1): R55.
Crivaro V, Di Popolo A, Caprio A, Lambiase A, Di Resta M, Borriello T et al. Pseudomonas aeruginosa in a neonatal intensive care unit: molecular epidemiology and infection control measures. BMC Infect Dis. 2009; 9: 70.
IFOWAHB International Forum of Water Hygiene in Buildings; 2012.05.10).
Wójcik-Fatla A, Stojek NM, Dutkiewicz J. Efficacy of the detection of Legionella in hot and cold water samples by culture and PCR. I. Standardization of methods Ann Agric Environ Med 2012; 19(2): 289-293.
Stojek NM, Wójcik-Fatla A, Dutkiewicz J. Efficacy of the detection of Legionella in hot and cold water samples by culture and PCR. II. Examination of native samples from various sources. Ann Agric Environ Med 2012; 19(2): 295-298.
Stojek NM, Dutkiewicz J. Co-existence of Legionella and other Gram-negative bacteria in potable water from various rural and urban sources Ann Agric Environ Med 2011; 18(2): 330-334.
Sroka J, Wójcik-Fatla A, Dutkiewicz J. Occurrence of Toxoplasma gondii in water from wells located on farms. Ann Agric Environ Med 2006; 13(1): 169-175.
Bojar I, Szymańska J. Environmental exposure of pregnant women to infection with Toxoplasma gondii-state of the art. Ann Agric Environ Med 2010; 17(2): 209-214.
Skotarczak B. Progress in the molecular methods for the detection and genetic characterization of Cryptosporidium in water samples. Ann Agric Environ Med 2010; 17(1): 1-8.
Sroka J, Wojcik-Fatla A, Szymanska J, Dutkiewicz J, Zajac V, Zwolinski J. The occurrence of Toxoplasma gondii infection in people and animals from rural environment of Lublin region – estimate of potential role of water as a source of infection. Ann Agric Environ Med 2010; 17(1): 125-132.
Dutkiewicz J, Cisak E, Sroka J, Wójcik-Fatla A, Zając V. Biological agents as occupational hazards – selected issues. Ann Agric Environ Med 2011; 18(2): 286-293.
Hollyoak V, Allison D, Summers J. Pseudomonas aeruginosa wound infection associated with a nursing home’s whirlpool bath. Commun Dis Rep CDR Rev. 1995; 5(7): R100-2.
Schlech, 3 rd WF, Simonsen N, Sumarah R, Martin RS. Nosocomial outbreak of Pseudomonas aeruginosa folliculitis associated with a physiotherapy pool. Can Med Assoc J. 1986; 134: 909-913.
Horcajada JP, Martinez JA, Alcon A, Marco F, De Lazzari E, de Matos A, et al. Acquisition of multidrug-resistant Serratia marcescens by critically ill patients who consumed tap water during receipt of oral medication. Infect Control Hosp Epidemiol. 2006; 27(7): 774-7.
Inglis TJ, Benson KA, O‘Reilly L, Bradbury R, Hodge M, Speers D et al. Emergence of multi-resistant Pseudomonas aeruginosa in a Western Australian hospital. J Hosp Infect. 2010; 76(1): 60-5.
Wise J. Three babies die in pseudomonas outbreak at Belfast neonatal unit. BMJ 2012; 344 doi: 10.1136/bmj.e592.
Anaissie EJ, Shawna L, Stratton M, Dignani C, Lee CK, Summerbell RC et al. Pathogenic molds (including Aspergillus species) in hospital water distribution systems: a 3-year prospective study and clinical implications for patients with hematologic malignancies. Blood. 2003; 101: 2542-2546.
Warris A, Corné H, Klaassen W, Jacques F, Meis GM, Maaike T et al. Molecular Epidemiology of Aspergillus fumigatus Isolates Recovered from Water, Air, and Patients Shows Two Clusters of Genetically Distinct Strains. J. Clin. Microbiol. 2003; 41: 4101-4106.
Anaissie EJ, Stratton SL, Dignani MC, Lee CK, Mahfouz TH, Rex JH et al. Cleaning patient shower facilities: a novel approach to reducing patient exposure to aerosolized Aspergillus species and other opportunistic moulds. Clinical Infectious Diseases. 2002; 35(8): E86-8.
Wallace RJ Jr, Zhang Y, Brown BA, Fraser V, Mazurek GH, Maloney S. DNA large restriction fragment patterns of sporadic and epidemic nosocomial strains of Mycobacterium chelonae and Mycobacterium abscessus. J. Clin. Microbiol. 1993; 31: 2697-2701.
Livni G, Yaniv I, Samra Z, Kaufman L, Solter E, Ashkenazi S et al. Outbreak of Mycobacterium mucogenicum bacteraemia due to contaminated water supply in a paediatric haematology-oncology department. J Hosp Infect. 2008; 70(3): 253-8.
Ribeiro NF, Heath CH, Kierath J, Rea S, Duncan-Smith M, Wood FM. Burn wounds infected by contaminated water: case reports, review of the literature and recommendations for treatment. Burns. 2010; 36(1): 9-22.
Inglis TJ, Benson KA, O’Reilly L, Bradbury R, Hodge M, Speers D et al. Emergence of multi-resistant Pseudomonas aeruginosa in a Western Australian hospital. J Hosp Infect. 2010; 76(1): 60-5.
Anaissie EJ, Penzak SR, Dignani MC. The hospital water supply as a source of nosocomial infections: a plea for action. Arch Intern Med. 2002; 162(13): 1483-92.
Valles J, Mariscal D, Cortes P, Coll P, Villagra A, Diaz E et al. Patterns of colonization by Pseudomonas aeruginosa in intubated patients: a 3-year prospective study of 1,607 isolates using pulsed-field gel electrophoresis with implications for prevention of ventilator-associated pneumonia. Intensive Care Med. 2004; 30(9): 1768-75.
Reuter S, Sigge A, Wiedeck H, Trautmann M. Analysis of transmission pathways of Pseudomonas aeruginosa between patients and tap water outlets. Crit Care Med. 2002; 30(10): 2222-8.
Pierson MD, Corlett DA. HACCP: principles and applications. Institute of Food Technologists. Publisher Van Nostrand Reinhold, New York (USA). Date of publication 1992.
Sheffer PJ, Stout JE, Wagener MM, Muder RR. Efficacy of new point-of-use water filter for preventing exposure to Legionella and waterborne bacteria. Am J Infect Control. 2005; 33(5 Suppl 1): S20-5.
Exner M, Kramer A, Lajoie L, Gebel J, Engelhart S, Hartemann P. Prevention and control of health care-associated waterborne infections in health care facilities. Am J Infect Control. 2005; 33(5 Suppl 1): S26-40.
Muscarella LF. Inconsistencies in endoscope-reprocessing and infection-control guidelines: the importance of endoscope drying. Am J Gastroenterol. 2006; 101(9): 2147-54.
The Health Protection Agency; (access: 2012.05.10).
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