Risk of Getting Nosocomial Water-borne Infections from the Main Water Systems in Hospitals

Abstract

Drinking water may be a risk factor for human infections if the water supply is contaminated with biofilm producing bacteria such as Legionella pneumophilae or Pseudomonas aeruginosa. Several situations have to be considered when water supply to new buildings is planned. The aim of this paper is to review situations that have to be considered in new buildings and give an example on a new water supply contaminated with biofilm producing water bacteria and the precautions introduced to eliminate the contamination. When new buildings are planned, it should be considered where to get the water and what is the microbiological quality of the water. If the water is contaminated there will be troubles from the beginning. The material for the pipes should be considered as biofilm is produced in greater amounts and faster in PEG pipes than in stainless steel pipes. The choice of material depend on the expected lifetime of the building, the dimensions of the pipes, and the choice of forceps, how often the taps are used and thereby the flow in the system. The higher flow the less and slower biofilm formation. It is important to reduce the number of taps to a minimum to ovoid "dead ends" if they are not or only seldom used. Alternatively all taps could be opened automatically regularly. It is important to establish precautions to ovoid contamination of the water system in the period from it are established until the building is taken in use. The period can be several month where the system can act as a "dead end" if no precautions, such as regularly opening of all taps, are taken. The microbiological quality of the water in the system should be controlled before the building is taken in use. In a new building, where the water supply and the water in the building was not controlled before the building was taken in use, extremely high total and Legionella germ counts were found. The water was disinfected with low concentrations of chloride with very little effect. After disinfection with high concentrations of chloride for few hours and placing a sterile filter at the water entrance both the total and Legionella germ count decreased to an acceptable level.