Waterborne nosocomial infections

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.