Removal of waterborne pathogens from liver transplant unit water taps in prevention of healthcare-associated infections: a proposal for a cost-effective, proactive infection control strategy

Clin Microbiol Infect. 2014 Apr;20(4):310-4. doi: 10.1111/1469-0691.12299. Epub 2013 Jul 23.


Hospital water supplies often contain waterborne pathogens, which can become a reservoir for healthcare-associated infections (HAIs). We surveyed the extent of waterborne pathogen contamination in the water supply of a Liver Transplant Unit. The efficacy of point-of-use (POU) water filters was evaluated by comparative analysis in routine clinical use. Our baseline environmental surveillance showed that Legionella spp. (28%, 38/136), Pseudomonas aeruginosa (8%, 11/136), Mycobacterium spp. (87%, 118/136) and filamentous fungi (50%, 68/136) were isolated from the tap water of the Liver Transplant Unit. 28.9% of Legionella spp.-positive water samples (n = 38) showed high-level Legionella contamination (≥10(3) CFU/L). After installation of the POU water filter, none of these pathogens were found in the POU filtered water samples. Furthermore, colonizations/infections with Gram-negative bacteria determined from patient specimens were reduced by 47% during this period, even if only 27% (3/11) of the distal sites were installed with POU water filters. In conclusion, the presence of waterborne pathogens was common in the water supply of our Liver Transplant Unit. POU water filters effectively eradicated these pathogens from the water supply. Concomitantly, healthcare-associated colonization/infections declined after the POU filters were installed, indicating their potential benefit in reducing waterborne HAIs.

Keywords: Healthcare-associated infection; POU water filter; hospital water supply; infection control; waterborne pathogens.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Bacteria / isolation & purification
  • Bacterial Infections / epidemiology
  • Bacterial Infections / prevention & control*
  • Cross Infection / epidemiology
  • Cross Infection / prevention & control*
  • Drinking Water / microbiology*
  • Fungi / isolation & purification
  • Health Facilities
  • Humans
  • Immunocompromised Host
  • Incidence
  • Infection Control / methods*
  • Mycoses / epidemiology
  • Mycoses / prevention & control*
  • Transplantation
  • Water Purification / methods*


  • Drinking Water