According to the U.S. Centers for Disease Control, nearly two million patients contract infections during their stays in U.S. hospitals (about 10% of all hospitalized patients), resulting in significant morbidity, mortality, and financial burden⁽¹⁾. Healthcare-associated infections (HAIs) in the U.S. resulted in 88,000 deaths in 1995⁽¹⁾. Their annual cost is estimated to be as much as $5.7 billion⁽²⁾, with patient costs of up to $50,000 per episode^(3-6). Microorganisms in healthcare facility water can cause HAIs. Tap water used for drinking, showering, bathing, ice preparation, and rinsing medical devices presents a potential hazard, especially to at-risk patients such as those in the following units:

• Bone Marrow Transplant
• Burn
• Hematology/Oncology
• Neonatal Intensive Care
• Pediatric Intensive Care
• Solid Organ Transplant
• Surgical Intensive Care
• Medical Intensive Care
• Cardiac Intensive Care
• Respiratory Intensive Care

Faucets and showers are also a source of aerosolized tap water. They produce vaporized water droplets that migrate on almost imperceptible air currents to distant locations within the healthcare environment. The water droplets, which carry bacterial, fungal, and protozoan pathogens, then settle on surfaces and contact patients and staff through touch contamination or inhalation by susceptible individuals.

Waterborne Pathogen Facts:

• Contamination of the healthcare facility water supply with potentially pathogenic organisms is very common.
• The magnitude of the problem presented by waterborne pathogens is widely recognized but mainly undetected as proper culturing methods are not routinely performed.
• The scientific literature has detailed a considerable number of studies that have established a genetic link between waterborne pathogens and patient infection^(7-13).
• Common waterborne pathogens of primary clinical significance include:

Bacteria: - Pseudomonas aeruginosa - Legionella pneumophila - Acinetobacter spp. - Klebsiella spp. - Nocardia spp. - Mycobacterium avium complex

Parasites: - Cryptosporidium parvum - Giardia lamblia - Acanthamoeba spp.

Fungi: - Aspergillus fumigatus - Fusarium solani

Waterborne Pathogens and Point-Of-Use Filtration:
Point-of-use 0.2 micron filters for water faucets, showers, ice machines, and water sources used for rinsing of medical devices provide a cost-effective alternative for managing waterborne pathogens that would otherwise enter the healthcare environment.

References:
1. Angelbeck, J. October 2004. Stopping Legionella and other waterborne pathogens in their tracks – a global perspective. Water Cond. And Purification. p.62-65.
2. Gaynes, R., C. Richards, J. Edwards, T.G. Emori, T. Horan, J. Alonso-Echanove, S. Fridkin, R. Lawton, G. Peavy, and J. Tolson. 2001. Feeding back surveillance data to prevent hospital-acquired infections. Emerg. Infect. Dis. 7(2):295-298.
3. Rosenthal, V.D., S. Guzman, O. Migone, C.J. Crnich. 2003. The attributable cost, length of hospital stay, and mortality of central line-associated bloodstream infection in intensive care departments in Argentina: a prospective, matched analysis. Am. J. Infect. Cont. 31(8):475-480.
4. Pittet, D., D. Tarara, and R.P. Wenzel. 1994. Nosocomial bloodstream infection in critically ill patients. Excess length of stay, extra costs, and attributable mortality. JAMA. 271(20):1598-1601.
5. Digiovine, B., C. chenowith, C. Watts, and M. Higgins. 1999. The attributable mortality and costs of primary nosocomial bloodstream infections in the intensive care unit. Am. J. Resp. Crit. Care Med. 160(3):976-981.
6. Warren, D.K., S.J. Shukla, M.A. Olsen, M.H. Kollef, C.F. Hollenbeak, M.J. Cox, M.M. Cohen, and V.J. Fraser. 2003. Outcome and attributable cost of ventilator-associated pneumonia among intensive care unit patients in a suburban medical center. Crit. Care Med. 31(5):1312-1317.
7. Anaissie, E.J., S.R. Penzak, and M.C. Dignani. 2002. The hospital water supply as a source of nosocomial infections: a plea for action. Arch. Intern. Med. 162(13):1483-1492.
8. Trautmann, M., H. Royer, E. Helm, W. May, and M. Haller. 2004. Pseudomonas aeruginosa: new insights into transmission pathways between hospital water and patients. Filtration Supplement 1:63-70.
9. Kline, S., S. Cameron, A. Streifel, M.A. Yakrus, F. Kairis, K. Peacock, J. Besser, and R.C. Cooksey. 2004. An outbreak of bacteremias associated with Mycobacterium mucogenicum in a hospital water supply. Infect. Cont. Hosp. Epidemiol. 25:1042-1049.
10. Conger, N.G., R.J. O’Connell, V.L. Laurel, K.N. Olivier, E.A. Graviss, N. Williams-Boyer, Y. Zhang, B.A. Brown-Elliott, and R.J. Wallace, Jr. 2004. Mycobacterium simiae outbreak associated with a hospital water supply. Infect. Cont. Hosp. Epidemiol. 25:1050-1055.
11. Trautmann, M., T. Michalsky, H. Wiedeck, H. Radosavljevic, and M. Ruhnke. 2001. Tap water colonization with Pseudomonas aeruginosa in a surgical intensive care unit (ICU) and relation to Pseudomonas infections of ICU patients. Infect. Cont. Hosp. Epidemiol. 22(1):49-52.
12. Rudnick, J.R. C.M. Beck-Sague, R.L. Anderson, B. Schable, J.M. Miller, and W.R. Jarvis. 1996. Gram-negative bacteremia in open-heart surgery patients traced to probable tap water contamination of pressure-monitoring equipment. Infect. Cont. Hosp. Epidemiol. 17(5):281-285.
13. Weber, D.J., W. A. Rutala, C.N. Blanchet, M. Jordan, and M.F. Gergen. 1999. Faucet aerators: a source of patient colonization with Stenotrophomonas maltophilia. Am. J. Infect. Control. 27(1):59-63.