Investigation of healthcare infection risks from water-related organisms: Summary of CDC consultations, 2014-2017

Infect Control Hosp Epidemiol. 2019 Jun;40(6):621-626. doi: 10.1017/ice.2019.60. Epub 2019 Apr 3.

Abstract

Objective: Water exposures in healthcare settings and during healthcare delivery can place patients at risk for infection with water-related organisms and can potentially lead to outbreaks. We aimed to describe Centers for Disease Control and Prevention (CDC) consultations involving water-related organisms leading to healthcare-associated infections (HAIs).

Design: Retrospective observational study.

Methods: We reviewed internal CDC records from January 1, 2014, through December 31, 2017, using water-related terms and organisms, excluding Legionella, to identify consultations that involved potential or confirmed transmission of water-related organisms in healthcare. We determined plausible exposure pathways and routes of transmission when possible.

Results: Of 620 consultations during the study period, we identified 134 consultations (21.6%), with 1,380 patients, that involved the investigation of potential water-related HAIs or infection control lapses with the potential for water-related HAIs. Nontuberculous mycobacteria were involved in the greatest number of investigations (n = 40, 29.9%). Most frequently, investigations involved medical products (n = 48, 35.8%), and most of these products were medical devices (n = 40, 83.3%). We identified a variety of plausible water-exposure pathways, including medication preparation near water splash zones and water contamination at the manufacturing sites of medications and medical devices.

Conclusions: Water-related investigations represent a substantial proportion of CDC HAI consultations and likely represent only a fraction of all water-related HAI investigations and outbreaks occurring in US healthcare facilities. Water-related HAI investigations should consider all potential pathways of water exposure. Finally, healthcare facilities should develop and implement water management programs to limit the growth and spread of water-related organisms.

Publication types

  • Observational Study

MeSH terms

  • Centers for Disease Control and Prevention, U.S.
  • Cross Infection / microbiology*
  • Cross Infection / prevention & control*
  • Disease Outbreaks / prevention & control*
  • Humans
  • Nontuberculous Mycobacteria / pathogenicity
  • Referral and Consultation / statistics & numerical data
  • Retrospective Studies
  • United States
  • Water Microbiology*
  • Water Supply*
  • Waterborne Diseases / microbiology*