The Hospital Tap Water System as a Source of Nosocomial Infections for Staff Members and Patients in West Bank Hospitals

Abstract

The number of nosocomial infections due to Legionella pneumophila and Pseudomonas aeruginosa is probably underestimated in many countries. This article discusses the risk of legionellosis due to Legionella and P. aeruginosa for patients and hospitals staff members from the water system in different Palestinian hospitals. A total of 134 water samples were collected in 2005 from six governmental hospitals located in the West Bank. L. pneumophila serogroup 2-14 was isolated from 33 of 53 samples, and P. aeruginosa was isolated from 17 of 81 before thermal disinfection. Thermal disinfection at 80 • C and progressively flushing the hot water outlets around the system was successfully efficient to eliminate Legionella and P. aeruginosa pathogens in water distribution systems. The current study is an example of how microbiological methods and site history may be used to successfully track the source of bacterial water contamination and subsequently remediate it. Thorough contaminant characterization and forensic source identification is important for designing of appropriate management strategies.

Opportunistic Premise Plumbing Pathogens. A Potential Health Risk in Water Mist Systems Used as a Cooling Intervention

“…In this study, higher concentrations of all OPPPs were detected in WMS biofilm samples than in water and bioaerosol samples, supporting the argument that biofilms play a significant role in OPPP regrowth and survival in water systems. These results are consistent with other studies [ 29 , 30 , 31 , 32 , 33 ]. In our study, P. aeruginosa was detected at higher concentrations in WMS biofilms when compared to all the other detected pathogens, a factor which can be attributed to the pathogen’s known ability to colonize and thrive better in biofilms than in the water phase [ 34 ].…”

Opportunistic Premise Plumbing Pathogens. A Potential Health Risk in Water Mist Systems Used as a Cooling Intervention

“…Several studies that have investigated the occurrence of OPPPs in premise plumbing systems such as domestic water taps, hospital faucets and showers have reported varying results ranging from zero detection of M. avium and N. fowleri in domestic tap water [27], to 15 % (n = 134) occurrence of N. fowleri in roof harvested rainwater tanks in Australia [51] and 13.5 % (n = 656) mean abundance of Mycobacterium species in showerhead biofilm samples from Europe and the USA [52]. Our investigation did not detect any M. avium nor N fowleri in all samples, water (30), biofilms (30) and bioaerosols (30). Although not isolated in any samples, the potential presence of M. avium and N. fowleri in WMS cannot be completely ruled out.…”

“…Several opportunistic premise plumbing pathogens including L. pneumophila, M. avium, P. aeruginosa, Acanthamoeba and N. fowleri have been found growing in premise plumbing systems such as drinking water distribution networks [28], building hot water systems [29], showers [5] and hospital tap water systems [30]. Several studies have investigated the occurrence of some of these pathogens and determined incidences of 38% for L. pneumophila in 108 water taps located in houses and offices across 31 states in the United States of America [31], 29% for P. aeruginosa in foot operated faucets in hospitals [32] and 67% for M. avium in 64 domestic water samples in the USA [33].…”

Health Risks Associated with the Use of Water Mist Systems as a Cooling Intervention in Public Places in the Pilbara Region of Western Australia

“…Transmission of P. aeruginosa can occur through exposure to contaminated water and is known to cause an aggressive pneumonia in people suffering from cystic fibrosis and nosocomial infections in hospital patients [25]. This bacterium has become one of the most commonly isolated infectious bacteria in hospital intensive care units [67], as well as in hospital tap waters [23,68], shower heads and hydrotherapy pools [69][70][71]. Chlorine disinfection resistance contributes to this opportunistic pathogen's survival in premise plumbing [43,72,73].…”

“…Whilst acknowledging that WMS using misting fans are effective at reducing ambient temperatures, a study examining the performance of water misting fans [2] determined that the resultant increase in relative humidity promoted the growth of bacteria and fungi. Extensive research of other premise plumbing installations, such as drinking water systems [12,13], cooling towers [14][15][16] (13)(14)(15), showers, water taps and faucets [17][18][19][20], have established that opportunistic premise plumbing pathogens such as Legionella pneumophila, Mycobacterium avium, Pseudomonas aeruginosa, Acanthamoeba and Naegleria fowleri have become ubiquitous in such systems. American research into the public health risks associated with OPPPs has focused on hospitals and aged care facilities [18,[20][21][22][23], whilst some Asian studies have centred on operational efficiency [2,3].…”