Professional Documents
Culture Documents
A Source of
HOSPITAL Concern for
Infections
by Judy A. Angelbeck, Ph.D.,
Girolamo A. Ortolano, Ph.D.,
Francis P. Canonica, Ph.D.,
and Joseph S. Cervia, M.D.
C
ontamination of the hospital water supply with potentially pathogenic Many waterborne microorganisms
organisms is very common. A wide range of bacteria, fungi, and protozoa are opportunistic pathogens that
in the water supply may be pathogenic and should be cause for clinical can increase the risk of infection in
concern. Common bacterial pathogens include Legionella spp., Pseudomonas immunocompromised patients. Such
aeruginosa, and some mycobacteria. Aspergillus is a particularly disconcerting mold patients who come into contact with
found in hospital water. While the pathogenicity of many waterborne parasites (e.g. contaminated tap water from point-
C ryptosporidium parv u m) has been well documented, some protozoa such as of-use sources such as faucets,
Acanthamoeba are not only pathogenic in their own right, but they can also protect showers, water fountains, and ice
bacterial pathogens such as Legionella pneumophila from destructive chemical machines are therefore challenged with
disinfectants and environmental forces as they support bacterial growth and replication. an increased potential for infection.
Point-of-use water filtration has not
Figure 1 only been shown to reduce infectious
complications, but it also serves as a
complementary strategy to systemic
water disinfection technologies. The
Schematic representation persistence of biofilm in healthcare
of the potential sites of facility water delivery systems provides
waterborne organism further justification for implementing
sequestration within the
point-of-use filtration.
plumbing supply to and
within hospitals. Adapted Overview
from Anaissie et. al.1
In a recent plea for action,
Anaissie et al.1 reviewed the potential
sources of water and mechanisms
through which water could serve as a
source of infectious microorganisms
(Figure 1). A recent extensive review
of topics relevant to waterborne
pathogens also outlines this risk.2
Healthcare-associated infections related to contaminated hospital Molecular methods used to establish waterborne microorganisms as
water supplies (tap water and water reservoirs only) with supporting identical to those found infection patients.
molecular relatedness data aligning the contaminating waterborne **Resistant means resistant to two or more clases of antibiotics.
organism to the patient infection.
Table 1A
BACTERIA
Bert et al. 19987 Lung, sinuses, urine DNA macroestriction analysis Resistant
Pseudomonas
Ferroni et al. 19986 Urine PFGE Not reported
aeruginosa
Ezpeleta et al. 199832 Blood ERIC-PCR,RAPD Not reported
Richard et al. 199433 Blood, ling, wound DNA typing, serotyping Resistant
Serratia marcescens Carlyn et al. 199837 Eye, stools PFGE Not reported
Acinetobacter Pina et al. 199838 Skin, wound PFGE, biotyping Not reported
baumannii
Aeromonas Picard and Goullet 198739 Blood Electrophoretic esterase typing Not reported
hydrophilia
Table 1B
Organism Source Site(s) of infection Method(s) Used to Link Antibiotic
Patient and Susceptibly of
Environmental Strains Organism**
MYCOBACTERIA
Mycobacterium Picardeau et al. 199715 Abscess, blood, bone, RFLP, PFGE, AFLP, PCR Not reported
kansasii sputum, stomach, urine
Table 1C
FUNGI
Figure 2
Atlantic Air
AD 1/2 H
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