Healthcare-associated infections or HAIs are infections people get while they are receiving health care for another condition. These infections can happen in all types of healthcare settings and are a significant cause of patient illness and death. According to the Centers for Disease Control and Prevention (CDC), 1 in 31 patients experience a healthcare-associated infection on any given day, costing healthcare systems in the United States $28 billion annually.
Many HAIs, including catheter-associated urinary tract infections, central line-associated bloodstream infections, surgical site infections, ventilator-associated pneumonia, and hospital-acquired pneumonia, are caused by organisms known to spread through water and biofilms. These organisms are commonly referred to as waterborne pathogens and, according to some studies, could be the cause of 20% of healthcare-associated infections.
Waterborne pathogens and healthcare-associated infections
Waterborne pathogens commonly linked to healthcare-associated infections include Pseudomonas, Legionella, Burkholderia, nontuberculous Mycobacteria, and Acinetobacter. Health risks associated with these pathogens can vary from mild infections to severe illnesses, and in some cases, they can even be life-threatening, particularly for high-risk individuals with compromised immune systems. Pseudomonas, Acinetobacter, Stenotrophomonas, non-tuberculous mycobacteria, and Burkholderia are bacteria frequently associated with antibiotic resistance challenges.
- Legionella: This bacterium thrives in water systems including cooling towers, hot tubs, and extensive plumbing systems. It is known for causing Legionnaires’ disease, a severe type of pneumonia.
- Pseudomonas: Found in soil, plants, and natural water sources, these bacteria can trigger serious infections in patients with compromised immune systems.
- Acinetobacter: These bacteria, primarily found in soil and water, have been implicated in dangerous infections in healthcare settings, particularly in patients on ventilators.
- Burkholderia: This group of bacteria is widely distributed in water and soil and can result in severe lung infections.
- Stenotrophomonas: These bacteria, found in water, soil, and plants, can lead to infections in the respiratory tract, bloodstream, and urinary system.
- Nontuberculous Mycobacteria: Typically present in water and soil, these bacteria can trigger lung infections in susceptible individuals, such as those with pre-existing lung conditions or suppressed immune systems.
Why water quality matters in healthcare facilities
Water quality plays a crucial role in healthcare facilities for many reasons, including:
- Approximately 20% of HAIs are caused by water.
- Water is everywhere in healthcare facilities.
- Water serves many functions in a healthcare setting and it is estimated that 65% of HAIs are associated with wet biofilm or the presence of moisture or liquid.
- Water is necessary to provide patient care and is used throughout the continuum of care.
- Hospitals treat high-risk immunocompromised patients who are at an increased risk of infection.
- On average, 1 in every 10 affected patients will die from their HAI.
- Water is not sterile. Pathogens live and grow in building water and plumbing systems, creating risk.
Factors that can increase water risk
Several factors can adversely impact water quality and increase the risk of healthcare-associated infections in hospitals, including water-utilizing patient equipment, water shutdowns or disruptions, and construction activities.
- Water-utilizing patient care equipment, such as respiratory therapy devices and wound cleaning tools, can introduce contaminants if not properly maintained and disinfected. Regular and meticulous cleaning and disinfection protocols must be in place to ensure the safety and integrity of these essential medical devices.
- Water shutdowns, disruptions, or events like water main breaks or flooding can compromise the water supply, leading to potential contamination and increased transmission of pathogens. It is crucial for healthcare facilities to have contingency plans and preventative water treatment systems in place, like sediment filtration, to mitigate the impact of such events on water quality.
- Construction and renovation activities in healthcare facilities can disturb water systems, potentially releasing harmful microorganisms and compromising the overall water quality. Adequate precautions and monitoring should be undertaken during these activities to minimize any potential risks.
What organizations can do to ensure safe water quality
To ensure safe water quality, healthcare organizations and healthcare professionals must prioritize clean water as part of their strategies to prevent infections. This includes implementing comprehensive control training and water management programs, conducting regular water quality testing, and maintaining water-utilizing equipment.
Systemic strategies to control and prevent biofilm in plumbing systems, such as through continuous disinfection of the entire building water system, are crucial to reducing healthcare-associated infections and ensuring patient safety.
References
Reynolds, D., Kollef, M. The Epidemiology and Pathogenesis and Treatment of Pseudomonas aeruginosa Infections: An Update. Drugs 81, 2117–2131 (2021). https://doi.org/10.1007/s40265-021-01635-6
CDC (2021, June 21). Health Topics – Healthcare-associated Infections (HAI). https://www.cdc.gov/policy/polaris/healthtopics/hai/index.html
Perkins KM, Reddy SC, Fagan R, Arduino MJ, Perz JF. Investigation of healthcare infection risks from water-related organisms: Summary of CDC consultations, 2014-2017. Infect Control Hosp Epidemiol. 2019 Jun;40(6):621-626. doi: 10.1017/ice.2019.60. Epub 2019 Apr 3. PMID: 30942147; PMCID: PMC7883772. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7883772/
World Health Organization. (2022). WHO launches first-ever global report on infection prevention and control. https://www.who.int/news/item/06-05-2022-who-launches-first-ever-global-report-on-infection-prevention-and-control
Yiek, W.K., Coenen, O., Nillesen, M., & et al. (2021). Outbreaks of healthcare-associated infections linked to water-containing hospital equipment: A literature review. Antimicrobial Resistance & Infection Control, 10(77). https://doi.org/10.1186/s13756-021-00935-6
