Outbreaks of healthcare-associated infections linked to water-containing hospital equipment: a literature review

Abstract

Background Healthcare-associated infections (HAIs) are a significant cause of morbidity and mortality in hospitalized patients. Water in the environment can be a source of infection linked to outbreaks and environmental transmission in hospitals. Water safety in hospitals remains a challenge. This article has summarized available scientific literature to obtain an overview of outbreaks linked to water-containing hospital equipment and strategies to prevent such outbreaks. Methods We made a list of water-containing hospital equipment and devices in which water is being used in a semi-closed circuit. A literature search was performed in PubMed with a search strategy containing the names of these medical devices and one or more of the following words: outbreak, environmental contamination, transmission, infection. For each medical device, we summarized the following information: the function of the medical device, causes of contamination, the described outbreaks and possible prevention strategies. Results The following water-containing medical equipment or devices were identified: heater-cooler units, hemodialysis equipment, neonatal incubators, dental unit waterlines, fluid warmers, nebulizers, water traps, water baths, blanketrol, scalp cooling, and thermic stimulators. Of the latter three, no literature could be found. Of all other devices, one or more outbreaks associated with these devices were reported in the literature. Conclusions The water reservoirs in water-containing medical devices can be a source of microbial growth and transmissions to patients, despite the semi-closed water circuit. Proper handling and proper cleaning and disinfection can help to reduce the microbial burden and, consequently, transmission to patients. However, these devices are often difficult to clean and disinfect because they cannot be adequately opened or disassembled, and the manufacturer’s cleaning guidelines are often not feasible to execute. The development of equipment without water or fluid containers should be stimulated. Precise cleaning and disinfection guidelines and instructions are essential for instructing healthcare workers and hospital cleaning staff to prevent potential transmission to patients.

Reducing the Risk of Healthcare Associated Infections from Legionella and Other Waterborne Pathogens Using a Water Management for Construction (WMC) Infection Control Risk Assessment (ICRA) Tool

“…The WMC-ICRA aids the practicing industrial hygienist in these prevention efforts by providing a systematic framework for the analysis of water systems during construction activities, when the system is more vulnerable, and conditions are more ideal for pathogen propagation [ 13 , 44 ]. Although healthcare workers and construction workers have a smaller documented burden of Legionella disease than patients [ 1 ], occupational exposures and disease cases are described in the literature [ 30 , 32 , 55 ] and disease may be underreported among workers compared to patients in healthcare settings [ 52 ].…”

“…Patient and medical equipment devices (e.g., ice machines, cardiac heater-cooler units, or sterile processing equipment) should be scheduled for installation in a timely manner to avoid high water age and premature bacteria growth and spread [ 13 , 32 , 33 , 34 ]. Operators must properly clean and maintain all patient and medical equipment using water per the manufacturer’s recommendation prior to use during routine operations [ 13 , 32 ]. Similarly, avoid premature installation of terminal fittings on fixtures (e.g., shower heads and hoses, aerators, faucet flow restrictors, screens, and filters in devices).…”

Experiences of Nurse Managers during the COVID-19 Outbreak in a Selected District Hospital in Limpopo Province, South Africa

“…As was found in this study, this lack of oxygen is concerning. The Médecins Sans Frontiers [ 48 ] indicates that the lack of continuous oxygen was experienced in Brazil, Democratic Republic of the Congo, Lesotho, Yemen, and elsewhere in South Africa. Other crucial resources that were a challenge during the pandemic included: shortage of antibiotics, shortage of linen and water, resulting in reuse of dirty linen.…”

The Role of a Rapid Prevention of Ralstonia pickettii Growth during Dialysis in a Frail Patient

“…In contrast, the residual organic carbon in purified dialysis water promotes substantial growth of planktic R. pickettii and can form biofilms inside plastic catheters. In a recent review, Yiek et al [16] found 11 reports of hemodialysis-associated outbreaks. Even if uncommon, they reported that tubing within the dialysis machine might be the site of biofilm development.…”

“…Even if uncommon, they reported that tubing within the dialysis machine might be the site of biofilm development. These authors observed that patients became infected because the dialysis water exceeded the maximum amount of chemical and microbial contaminants, due to lack of disinfection [16]. Moreover, treated water is often stored in reservoirs, where it is distributed to dialysis machines.…”