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

J Med Microbiol. 2014 Oct;63(Pt 10):1247-1259. doi: 10.1099/jmm.0.075713-0. Epub 2014 Aug 7.


The purpose of this review is to discuss the scientific literature on waterborne healthcare-associated infections (HCAIs) published from 1990 to 2012. The review focuses on aquatic bacteria and describes both outbreaks and single cases in relation to patient characteristics, the 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 the prevention and control measures adopted, information and recommendations are given. A total of 125 reports were included, 41 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. The intensive care unit was the most frequently involved setting, but patient characteristics were the main risk factor, independent of the ward. As it is difficult to avoid water contamination by microbes 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 in terms of tap-water exposure and also their personal hygiene, and should regularly use sterile water for rinsing/cleaning devices.

Publication types

  • Review

MeSH terms

  • Bacterial Infections / epidemiology*
  • Bacterial Infections / etiology
  • Bacterial Infections / microbiology
  • Bacterial Infections / prevention & control
  • Burkholderiaceae / classification
  • Burkholderiaceae / isolation & purification*
  • Cross Infection / epidemiology*
  • Cross Infection / etiology
  • Cross Infection / microbiology
  • Cross Infection / prevention & control
  • Humans
  • Infection Control / methods
  • Legionellaceae / classification
  • Legionellaceae / isolation & purification*
  • Pseudomonadaceae / classification
  • Pseudomonadaceae / isolation & purification*
  • Risk Factors
  • Water Microbiology*