Etiology, source and prevention of waterborne healthcare-associated infections: a review.

The purpose of this review is to discuss the scientific literature on waterborne healthcare-associated infections (HCAI) published from 1990 to 2012. The revision focuses on the aquatic bacteria and describes both outbreaks and single cases in relation to patients characteristics, settings, and contaminated sources. An overview of diagnostic methods and environmental investigations is summarized in order to provide guidance for future case investigations. Lastly, on the basis of prevention and control measures adopted, information and recommendations are given. A total of 125 reports were included, 41 of them describing hospitalized children. All cases were sustained by opportunistic pathogens, mainly Legionellaceae, Pseudomonadaceae and Burkholderiaceae. Hot water distribution systems were the primary source of Legionnaires' disease, bottled water was mainly colonized by Pseudomonaceae, and Burkholderiaceae were the leading cause of distilled and sterile water contamination. Intensive care unit was the most frequently involved setting but patient characteristics are the main risk factor, independently of the ward. As the microbes water contamination is difficult to be avoided and disinfection treatments may be insufficient to control the risk of infection, a proactive preventive plan should be put in place. Nursing staff should pay special attention to children and immunosuppressed patients to avoid tap water exposure, also for their personal hygiene, and to regularly use sterile water for rinsing/cleaning devices